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HANDBOUND 
AT THE 



LN1\ ERSITY OF 
TORONTO PRESS 



.-<-?' 




The Medical Record. 



% ^m\-Mni\]\\] 3(ourn;il of ^IcMcuic (iiiii ^iinuri)'. 



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EDITED BY 




GEORGE F. SHRADY, A.M., M.D. 



iJoluSu 7. 



MAECII 1, 1872— DECE:y:BEE 16, 1872. 



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XEAV YORK: 

\vilil,ia:m ^vooD & compaxy, 

27 GREAT JOXES STREET. 



n 



POOLE^ & MACLAUCHLAX, 

PRINTERS AND BOOK. HINDERS, 
205-213 East \2ih St. 



INDEX TO VOLUME VII. 



Abdomen, impalement of, 198. 

Abortion, frequency of retained placentn in, .'520. 

Acid nitrate of mercury, in induration of womb, 151. 

Acne, remarks on, 54(5. 577. 

Aconite-poisoning, 3G ; test for root of, 515. 

^tbylidenchloride, 275. 

After-pains, citric acid in, 108. 

Aiken, S. C. , a resort for invali Is, 43. 

Air- passages, death as a cause of disease of. 388. 

Air, compressed as a remedial agent. 31 ; on poisoned, 

55!. 
Albuminuria, cathartics in, 30; during fertility, 442. 
Albuminuric retinitis, OG. 
Alcohol, action of, 346, 407 ; treatment of wounds by, 

223. 
Alkaloids, comparative value of, 328. 
AUbutt, T. C, review of work by, 20. 
Althof, Dr. H.. canthoplasty, 34. 
Alumni Association of Collejje Physicians and Surgeons, 

93 ; University of New York, 95 ; institutions, 399. 
American Medical Association, report of, 169, 201, 277, 

426. 
American Ophthalmol ogical Society, review of transac- 
tions of, 19. 
American Otological Society, report of, 331. 
American Pharmaceutical Association, officers of, 527. 
American Public Health Association, 455, 523. 
Amherst College, Mass., notice of, 334. 
Ammonia, hydrochlorate of, 390. 
Amyloid disease, prevented by alkalies, 276. 
Anesthesia, discovery of, 187, 336 ; review of work on, 

146. 
Anesthetic mixture, the, 299. 
Anjesthetics, administration of, 396. 
Anemia, progressive, 343. 
Aneurism, remarks on, 304, 347, 472, 540. 
Angioma caverncsum, case of, 120. 
Animalcula, poisonous effects of, 397. 
Animation, case of suspended. 46. 
Animals, a new hospital for, 96. 
Aniline colors, adulteration with sugar. 261. 
Ankle-joint, compound dislocation of. 251. 
Anus, imperforate, 312 ; nourishing by, 368. 
Aphonia, 390. 

Areolar, vascular tumor of labium, 303. 
Army News. 41, 92. 118, 166, 237. 250, 284, 310, 333, 

359, 382, 403, 427, 455, 525, 550. 
Anny, the medical corps of the, 264. 
Arnold, Dr. E. S. F., letter from, 249. 
Arnott, Henry, notice of work by, 401. 
Arsenic in dyspepsia, 104. 
Arterioles, tonicity of, 511. 
Artery compressor (illustrated). 213. 
Artery constrictor, with cases. 52. 
Artesian wells propagating disease, 152. 
Ascites, a novel method for tapping, 36. 
Aspergillus, case of, 419. 
Aspirator, the, 473. 

Asthma, a cause of, 442 ; treatment of, 443. 
Astigmatism, determination of, 58, 347. 
Astragalus, cases of, disease of, o97. 
Atlee, Dr. W. L. , review of work by, 543. 



Atlo-axial disease. 510. 

Aural-catarrh, review of work on, 353 ; polypus, rapid 

development of. 418. 
Autopsies, neces.sity for, 536. 

B. 

Bailey, Dr. James S., death after child-birth, 385 ; snake- 
bites. 413 

Baptisia tiuctoria in typhoid, 465. 

Barker, Dr. B. F.. puerperal thrombosis, 521. 

Bathing, directions for, 382 ; reduced to a science, 91. 

Battey, Dr. R., on cystotomy, 381. 

Beard and Rockwell, Drs., on electro-surgery, 292, 434. 

Beef essence, frozen, 300. 

Beef -tea, worthlessness of, 223 ; new method of making, 
296, 323. 

Beer, adult-eration of, 551. 

Bell. Dr. A. N. , on quarantine, 66. 

Bell, Dr. John, of Philadelphia, death of, 432. 

Belladonna, antidotal preparations of, 159. 

Bellevue Hospital Medical College, 93 ; House Staff, 
431. 

Bennett, Dr. E. P., dislocation of shoulder, 52. 

Bennett, Dr. J. H., review of work by, 203. 

Bennett, Dr. W. H. , dust as an exciting cause of disease, 
388. 

Berberi, case of, 468. 

Bile, urea in, 346 ; detection of, 197. 

Biliary calculi, large, 360. 

Births, male and female in U. S. , 336. 

Bladder, cancer of, 276 ; puncture of, 289, 323 ; rup- 
ture of, 205, 356, 394, 457 ; impalement of by broom- 
stick, etc., 518. 

Black list, the physician's, 250. 

Blind, the,'^in Massachusetts, 288. 

Blindness, from cerebro- spinal meningitis, 341 , photopho- 
bia in, 56. 

Blood crystals, their physiological importance, 242. 

Blood, transfusion of, 58. 

Blotting-paper, incrusted, from nostril, 156. 

Bodenhamer, Dr. W., traumatic hemorrhage of rectum 
(illustrated), 361. 

Bones, notice of work on disease.=; of, 279. 

Booth, Hamlet of, psychologically considered, 287. 

Bougie-a-Boule, a new, 167. 

Bradley, Dr. E., letter from, 250. 

Brain, effects of removal of, 372 ; colloid degeneration 
of, 228 ; in uraemia. 579. 

Breath, organic matter in, 335. 

Briddon, Dr. Chas. K., elastic artery compressor {illus- 
trated), 213 ; surgery of male urethra, 217, 289 ; 
tubular aneurism, 472. 

Bright's disease, in children, 345 ; eye in, 84 ; work on, 
23. 

Brigham Hall, report of, 428. 

Bromide of potassium, 328 ; notice of work on, 516. 

Bronchitis, muriate of ammonia and carbolic inhalation 
in, 274, 297. 

Bronsou, Dr. E. B. , syphilis corpuscle, 138. 

Brown-Sequard on epilepsy, 472, 517. ^ 

Buck, Dr. A. H. , on Ear Practice, 570. 

Buck, Dr. Gurdon, tracheotomy, 12; infra-auricular 
tumor, 517. 



i^S2 



Index to I'ol. V'JI. 



Bulklty. Dr. H. D.. notice of denth of. 4.S. 

IJulkh-y, Dr. L. D.. cliniciil thernioiiu-tn-. UO. 

Bull. Dr. C. S. , atrophy of optic nerve, :!i:{. 

Biinistoud. Dr. F. J.. Lo8torfer'« corpuHcles, 1(14. 210. 

Bullet, rcniovul of ftoni cranium. t2(M). 

Bullets, l»(»(l practite of prubiug for in cavities, o25. 

Bunker. Dr. E. S , clay (ircMings in variola, 40. 

Burns, treatment of. 2'J(i. 

Burrall, Dr. F. A., oxton.sion of wrist (illimlnidd), 143; 

ua.s.al doucbe, (Jo ; carbolic acid internally, 52.'). 
Butler, Dr. S?. W., review of work by, 22. 
Byrne. Dr. J., on electric cautery in uterine surgery 

(illuiftrateci), 529, 55;i. 



Coesarean Foction. ;U2. lis. 

Calabar bean and chloral. 101 ; in constipation. 413. 

Calculi, 27; in the bladder, 230 ; chlorofonu in treatment 
of. 104. 

Camphor, monobromate in delirium tremens, 372 ; and 
bromine, lOo. 

Cancer, rcniarks on different characters, and treatment of, 
\',(K 22->. 2:)7, 21)1. :^7!J. 40. 512, 594. 

Cancruni oris, treatment of. 414. 

Cantharidatc of pota.<h. 540. 

Cantharides. poisoning by, 807. 

Canthoplasty in conjunctival and corneal aflFections, 34 ; 

Carbol. 302. 

Carbolic acid, antidote for, 84 ; as an anesthetic, 231 ; 
internally, 525. 

Caro. Dr. S. A., novel method of tapping, 30. 

Carrol's, Dr. A. L., knot-tier (ilhi.stratfed), 3U4. 

Castle, Dr. F. A., on nocturnal enuresis, 453. 

Castor-oil made palatable, 311. 

Cataract, extraction of, 145, 346. 

Centipede, sting of. 413. 

Cephaljematoraa, 371. 

Cerebral abscess. 297. i 

Cerebral paralysis, growth of nail as a means of prog- 
no.sis of. 108. 

Cerebro -spinal meningitis, remarks on characters and 
treatment. 34, 51, 71, 102, 206, 345, 265, 268, 384, 
297. 2!i9, 341, 466. 

Chapman, Dr. E. N., review of work by, 446. 

Ch;.rity Hospital Report. 343. 

Chemistry and materia medica, report of Section of Ame- 
rican Medical Association of, 189. 

Chicago, eflfects of fire in, 168. 

Chinese surgery, 47. 

Childbirth, death after. 385. 439. 

Chloral hydrate, remarks on as a remedial agent in dif- 
ferent diseases, 104, 105, 106, 197, 324, 329, 415, 416, 
420. 

Chloride, in place of bromide, of potassium, 31. 

Cholera, remarks on, 9, 297, 323, 360. 

Cholera infantum. 394. 443. 

Chloroform, discovery of, 335 ; uses of, 104, 252. 

Chronic cjstiiis. 381. 

Cinchona, action of. 303 ; tree, cultivation of, 188. 

Cilia, method of destroying, 324. 

Circocele.' operation of, 303. 

Clarke, Dr. H. K.. on cys otomy, 220. 

Clavicle, apparatus for fracture of, 258. 

Clay dressings in variola, 40. 

Cloves, oil of, as a preservative, 335. 

Coal oil in congestion. 372. 

Cobbold. Dr. S. . notice of work bj', 471. 

Cocoanut-milk. 275. 

Cod -liver oil, comparative value of. 329. 

Cohen. Dr. J. Soils, notice of work by. 400. 

Copaiba, new mode of administering. 324. 

College of Physicians and Surgeons, commencement of, 
93. 

Collodion, cheap. 391. 

Communists as lunatics. 408. 471. 

Condylomata ; non-syphilitic, removal of, 151 ; endo- 
follicular, 511.' 



Conjugal onanism. 43. 

Conjunciiviiis. treatment of, 304. 509. 

ConHonant HoundH. caHos illuBirating. 40. 

Constipation, in uterine disease, treatment of. 108, 442. 

Convulnions. acute ura-mic, use of opium in, 160; forci- 
ble diliverv' for. H2. 

Corals, notice of work on. 378. 

Coreal ulcer and dental abscess, 418. 

Coq)ulence. causf s of. 16K. 

Correspondence. 39. 70, 91, 117. 149, 164, 311. 234, 247, 
2K4, 308, 332, 358. 379, 403. 426, 477, 525, 549. 

Corrosive sublimate, hypodennic injection of, 59. 

Consumption, review of work on. 203. 

Cow's milk, reaction of. 443. 

Creosote, tests for j)urity of. 415. 

Croton water siipi»ly, the. 326, 429. 

Croup, management of. 228. 

Cruse. Dr. Thomas K . fracture of leg, 140. 

Curid mango, value of, 329. 

Cylindrical glasses, the first pair, 359. 

Cystitis in female, treatment of, 84, 107. 

Cystotomy, remarks, 220, 381, 549. 

D. 

Dalton, Dr. E. B., death of, 385. 

Dalton, Dr John C, review of work by. 86. 

Dana. Dr. James D. , notice of work V>y. 378. 

Dawson. Dr. B. F.. a new vaccinator {illustrated), 117. 

Dead bodifs. liquefying, 228. 

Deaf and Dumb, the uneducated, 336. 

Deafness, cured by electricity, 57 ; caused by cerebro- 
spinal meningiti.s. 341. 

Death, ap{)arent. remarkable case of. 335 ; test of, 574. 

Delaware State Medical Society, notice of, 312. 

Delirium tremens, chloral in, 197. 

Delivery, m.-xnual. in con\'ul8ion8, 82. 

De Marmou. Dr. P.. case of. 187, 349, 309. 

Denionomania and witchcraft, 96. 

Dental inegularity, treatment of, 153. 

Dentigerous cysts, 58. 

Dentists in the U. S. . 95. 

Department of safety, the proposed, 61. 

Derby. Dr. A. H , tenotomy in myopia, 64 

Diabetes in India, 28 ; treatment of, 367. 

Diabetic nvine. new matter in. 251. 

Diarrhoea, infantile, treatment of, 228. 

Dickson. Prof. S. H.. death of, 163. 

Digitalis, an anaphrodisiac, 33. 

Diphtheria, recovery after tracheotomy for, 12 ; treat- 
ment of. 297. 

Diploma traffic, the. 117. 247, 514. 

Disinfectants, the best. 329. 

Dispensaries, first to suggest the idea of, 335. 

Dissecting wounds, treatment of, 197. 

Doctor's local quarrels, 301. 

Donnelly, Dr. M.. skin grafting, 573. 

Dowell. Dr. Greenville, new speculum (illuitrated), 402. 

Drowning, prevention of death from, 546. 

Drug-bill, remarks on. 17. 

Drunkenness, ])roposed law against, in France, 288. 

Dry earth a*; a surgical dressing. 420. 

Dubois, Dr. H. A., climate of San Rafael, 135. 

DufiBeld. Dr. Edward, baptisia tinctoria, 465. 

Dugorg oil, 382. 

Duncan, Dr. J. M., notice of work by, 304. 

Dunning, Dr. W. B. , death from ether, 411. 

Dust, as an exciting cause of disease in air-piissages, 
388. 

Dwyer. Dr. John, cerebro -.spinal meningitis, 51. 

Dyspepsia, treatment of, 60, 104, 346. 

Dysentery, chlorate of potash in, 351. 

E. 
Ear, removal of bodies from, 395 ; review of work on, 19 ; 
the labyrinth of, 232 ; catarrh of, 444 ; unusual cases 
of disease of, 570. 
Earth in surgery, review of work on, 205. 
1 Eczema, hesitation in curing, 43. 



Index to Vol. VII. 



583 



Editorial articles, 17, fil, >S5, 10!), 15:3, 15r), 201, 229, 277, 
:301, 82r), :349, P>78, 308, 421, 44"), 409, 518, 541, 575. 

Edson, Dr. B., on c.incer doctors, 879. 

Education, .sanitary aspects of, 898. 

Elbow, movement plan in fracture of, 418. 

Elbow -joint, excision of, 42. 

Electric cauter3' in uterine surgery, 529, 553. 

Electricity, review of works on, 110, 515. 

Electro-surgery, researches in, 202, 484. 

Electro-therapeutics, 189, 281, 540. 

Electrolysis in stricture of rectum, 209. 

Emnienagogue.s, 29(>. 

Empyema, latency of symptoms in, 86 ; cases of, 357. 

Eueuresis, nocturnal. 848, 458. 

Epidemic diseases, report of section of American Medi- 
cal Association on. 263. 

Epilepsy, character and treatment of, 198, 226, 276, 337, 
472. 

Epulis, microscopic character of. 59. 

Erectile tumors, electrolysis in, 293. 

Erysipelas and surface thermometry, 1 94 ; abortive treat- 
ment of. 200. 442. 

Ether as a beverage, 168; death from, 408, 411 ; effects 
of iu labor, 416 ; the first insensibility from, 252 ; 
glue, 328. 

Eucalyptus, 298. 

Evolution, theories of, 396. 

Excisions, antiquity of, 549, 577. 

External iliac, ligation of, 105. 

Extra-uterine [regnancy, 467. 

Extraction operations. 848. 

Eye, syphilitic inflammation of, 58 ; relation of diseases 
of to other diseases, 337. 



Fabrics, to render non-inflammable, 222. 

Favus, treatment of, 56. 

Fecundation, artificial, 222. 

Fecundity, extraordinary, 264 ; a work on, 204. 

Fees in California, 287. 

Female, calculus in, 417. 

Female Dentists, 358. 

Female patients, our relations to our. 469. 

Female physician of the olden time, 403. 

Femur, cases of fracture of, 104, 198, 254 ; lengthening 
of in sj-philis, 368. 

Fermentation, remarks on, 511. 

Fever, mixture for. 59 ; lacto-phosphate of lime in, 226 ; 
and sewers, 227. 

Fibula, fracture of, treatment of, 41 8. 

Finnell, death from heart disease, 112 ; on whiskey drink- 
ing, 451 ; on aboi-tion, 520. 

Flint, Dr. A., aneurism and its relation to syphilis, 37. 

FUnt. Dr. A., Jr., notice of work by, 423. 

Fostal hypertrophy. :>47 ; remains, attachment of, 228. 

Forced Delivery, 107. 

Fork, swallowing of a. 46. 

Fortun, Dr. C. A., trismus nascentium, 343. 

Foundlings and foimdling institutions, 481. 513. 

Franciscan Hospital, quarterly report of, 286. 

Fra^er. Dr. William, death of, 'diS. 

Frisbie, Dr. C. W., on pessema, 308. 

G. 

Gall-stone, a large, 286. 

Galvanic current, therapeutic action of, 328. 

Galvanism, strictures, treatment by, 270. 

Galvano-caustic, amputation by, 516. 

Galvano- Puncture Needle (illustrated), 162,461. 

Gangrene of mouth, 462. 

Gant, Dr. F. J. , notice of work by, 302 ; Dr. James, 

notice of work by, 24. 
Gastric Tubuli. 372. 
Gastro-hysterotomy, 227. 
Gelsemium in irritable bladder, 57. 
German surgeons, annual congress of, 234. 
Gibbons, Dr. H. , letter from, 880. 
Gleet, an astringent for, 105. 



Glue bandage in fractures, 275. 

Goitre, treatment of, 847. 

•Gonorrhoea, remarks on character and treatment of, 199, 
225, 299. 468. 

Good-Bll, Dr. William, membranous cast of vagina, 40. 

Gossypirtm as an anodyne. 108. 

Gouley, Dr. J. W. S., on rupture of bladder, 457; ure- 
thral fever, 409; retention of urine, curious case of, 
483. 

Graduation of improper persons, 70, 153, 168, 258. 

Green, Dr. T. Henry, notice of work by, 88. 

Gross, Dr. S. D., notice of work by, 352. 

Grotto near Pistoie, curative properties of, 46. 

H. 

Habershon, Dr. S. 0., notice of work by, 424. 

Hachenberg, Dr. G. P., on tannin packing, 842. 

Hairs, changes in direction of, 574. 

Hare-lip, cases of, 540. 

Hemato-crystalline with irrespirable gases, 242. 

Hematoma, complicating internal urethrotomy, 291. 

Hematoxylin, 894. 

Hamilton. Dr. F. H., notice of work by, 423. 

Harle.y, Dr. G. . notice of work by, 802. 

Hay-fever, notice of work on, -878. 

Hayes, Dr. R. T., letter from Japan, 250. 

Health Board and Xuisances, 350. 

Health Council, a national, 180. 

Health Department and Committee of Safety, 61. 

Health Officer of the Port, 18. 

Heart, voluntary arrest of action of, 261, 268; anomalous 
malformation of. 111 ; .suppcsed cause of disease of, 
58, 804 ; death from diseases of, 112 ; needle in the, 
288, 416 ; nitrite of amyl in neuralgia of, 392 ; re- 
marks on disease of, 419 ; diseases of in pregnancy, 
439 ; strain of, 444 ; vegetations in auricle of, 521 ; 
statistics of disease of, 420 ; calcareous infiltration of, 
442. 

Hectic Fever, 296. 

Hematuria, malarial,- 418. 

Hemicrania. quinine and digitalis in, 105. 

Hemoptysis, remarks on, 60, 207. 

Hemorrhages, secondary, 120 ; post-partum, 443. 

Hemorrhoids, a new forceps for (illustrated), 26; treat- 
ment by galvani.sm, 881. 

Hemp-saw in excision of polypi, 149. 

Hemiplegia in syphilis, 297. 

Hermaphroditism, case of, 346. 

Hernia, novel methods of treatment for. 57, 105, 346, 414. 

Herpes zoster, collodion in, 371. 

Hewit, Dr. H. S., on Symes' amputation, 156. 

Hewson, Dr. A., review of work by, 205. 

Hiccough, management of. 276. 

Hip Disease, operation for, 2^9, 410. 

Homeopathy and Allopathy, 309, 383. 

Honolulu, climate of, 427. 

Horse, large intestinal calculus in, 335 ; influenza. 478. 

Hospital Appointments. 109, 211, 376. 

Hospital Report of a novel sort, 18. 

Hunter. Dr. W. C, on pepsin, 477. 

Hudson. Dr. E. D., on paraplegia (illustrated), 339. 

Humerus, luxatioa froin muscular contraction, 467. 

Hutchison, Dr. J. C, on syphilization, 305. 

Hutton. Dr. Allen C. on homeopathy, 309. 

Hydatid cysts passed per rec;um. 420. 

Hydrocele, new treatment of. 104. 

Hydrochlorate of aniorphia. 106. 

Hydromatous cysts, 897. 

Hydrophobia, remarks on. 200, 348, 419. 

Hydro-pneumothorax. 512. 

Hymen, persistence of after marriage. 335. 

Hysteria, fatal case of, 415 ; ischuria of, 57. 



niac artery, ligation of, 41 7. 

Illinois State Medical Society, notice of, 288. 

Impetigo and vaccinia. 371. 

Incontinence of urine in children, 417. 



584 



Index to Vol. VII. 



Increase in population. reinarkB on, 17. 

Indiana Stato Medical .Society, notica of, 884. 

Indipostion n-id its imn t^roraent, 348. 

Inebriety, horedit^rj-. 2;{J). 

Indican, origin of in nr.no. :M5. 

Infants, rare mode of djath in, 231 ; food for, :!91 ; work 

on. ;{77. 
Infantile paralysis, electricity in. 834. 
Infirmaries, first establish mont of, 48. 
Influenza among' horses, 47!). 
Infra-auricular tumor. .")17. 
In.!,'alls. Dr. E. F.. on cy.stotomy, 550. 
Insane, ophth.almoloffical examination of the, 152. 
Insanity, remarks on, 151, 275. 27G, 372. 
Intemperance, comic law of, 480. 
Interdental si)lint. :{72. 
Intermaniui^'c. remarLs on. 359. 
Intermittent fever, carbolic acid in, 224. 
Intestinal obstruction, 20S, 
Intus.susception. case of, 520. 
Iodine, tinct. of, bleached, 510. 
Iritis, atropine in syphilitic, 300. 
Iron, incompatibles. 00. 
Irreducible hernia, a case of, 151. 
Ischemia, case of. 339. 
Ischium, excision of, 198. 

J. 
Jackson. Prof. Samuel, death of , 118. 
Jacobi, Dr. A., letter from, 213 ; specimens by, 206 ; on 

foundling institutions, 481. 
Janeway. Dr. E. G. . pathological specimens by, 37, 205, 

304, 305. 35() ; on post-mortems, 536. 
Jaw. the man with the " iron." 47 ; treatment of fracture 

of. 391. 4G0 ; excision of, 540, 579. 
Jeffries, Dr. B. Joy, notice of work by, 146 ; 
Jervina. experiments with, 130. 
Jewish mortality, 335. 

K. 

Kerosene oil in chronic rheumatism. 414. 

Kidney, effects of various liquors on, 30 ; notice of work 

on diseases of. 23 ; pathology of contracted, 395 ; 

remarivs on fatty, 60. 
Knapp. Dr. H. , on cerebro-spinal meningitis, 341 ; on the 

ear. 232. 
Knee-joint, amputation of. 32, 57 ; resection of, 235, 

256 ; cartilage from. 300. 
Koumiss, preparation of, 408. 



Labor, cases in a private practice of thirty-nine years, 
390 ; death after, 385. 439 ; electricity in, 347 ; force 
and version in, 151 ; manual force to uterus in, 
108; not a painful process, 467; premature artifi- 
cial. 418. 

Laborde. Dr. J. V., notice of work by, 471. 

Lachrv'mal sac. catarrh of the, 510. 

Lactic acid as a remedial agent. 329. 

Laryngeal growths, causes of, 224. 

Laryngeal mirror-holder (illustrated), 358. 

Laryngoscopy. 199. 

Larvnv. svphilitic ulcerations of, 32; papilloma of, 
"411. 

Lead -poisoning from snuff, 56. 

Lee. Dr. B., notice of work by, 400. 

Lee. Dr. C. A. , notice of death of. 4. 

Leg. treatment of fractures of, 140. 

Leucin and tyrosin, 60. 

Leucocythjemia in a pig, 296. 

Leucocyte, the. 191. 

Leucaemia, a case of, 280. 

Leucorrhoe i. treatment of. 392. 

Lewis, Dr. Z., Edwards' folding saw, eta (illustrated), 
161. 

Libraries of New York, 287. 

Lidell. Dr. J. A., carbolic inhalations in chronic bron- 
chitis. 27^. 



Light, blue, as a stimulant. 343. 

Lijfhtning, los.s of life by. 2S8. 428. 

Lime, phosphate as a remedy, 220 ; locto-phosphate of, 

413. 
Lipoma, removal of an extensive, 251. 
Lips, chronic h^'purtrophy of, 59. 
Litbiasin. 395. 
Lithotomy and lithotrity, 150. 41fS, 430, 442 ; first case 

of in New York, 2f[4. 
Little. Dr. J L.. tumor of jaw. 520. 
Loring. Dr. E. G , operation for Ht.abismus. 97, 
Lostorfer's corpu.scles. 27, 138, 155, 104, 210. 
Lung, absence of. 108. 
Lupus of the extremities. 234. 
Lymphatic uiJema, 370. 
Liver, narrow escape of in paracentesis ; furrowed, a case 

of. 2S1, 357. 
Loomis, Dr. A. L. , on empyema, 357. 

M. 
Macdonald. Dr. A. E., small-pox statistics, 310, 305, 

142. 
Iklacula lutea, di.stancG of from optic disc. 32. 
Magnetic and mineral springs of ALchigan, notice of 

work on, 425. 
Magnetic wells, 189. 

Maine Medical Association, notice of, 334. 
Malarial fever, hemorrhagic, 197, 396. 
Mammary tumor, 112. 

Manhattan Eye and Ear Hospital reports, 144 
Mann, Dr. Ed. C. on skin di.seases, 412. 
Markoe, Dr. T. M., review of book by, 279. 
Marriage rp/s^.s celibacy, 41. 
Massachusetts Gen. Hospital. 384. 
Mason. Dr. E.. fajcal accumulations, 114. 
Ma.sturbation. a case of. 453. 
Mathewson. Dr. A., on criticism. 212. 
Meat, new method of preserving, 46 ; extract of, 415. 
Medical College commencements, 72, 85. 
Medical Library and Journal Association, reports of. 

65. 
Medical diploma trade. 167. 380. 
Medical education, 176, 186 ; fees, 43 ; services, forced, 

18. 171. 
Medical Register, notice of, 353; and the profession, 421, 

445, 453, 525. 
Medical experts, 189. 
Medical literature, report on, 177. 
Medical and Surgical History of the War, 230. 
Medical schools, efficiency of, 541. 
Medical Society of West Virginia, notice of, 312. 
Medical Societv of County of New York, reports of, 33, 

90, 231. 448. 523. 
Medical staff of U. S. Xavy, 432. 
Medical World, final notice of. 64. 
Medicine, history of, notice of. 471. 
Membrana tympani. anatomy of. 54 ; wounds of. 56. 
Menstniation, temperature during, 151 ; phenomena of, 

512 
Mephitis occidentalis, 466. 
Morcurv, injection in syphilis, 511. 
Methyline, bichloride of. 45, 369. 
Miller, Dr. M. N., on mydriasis, 387. 
Military Academy, West Point. 326. 
Milk, artificial. 45. 

Mind, influence of in therapeutics. 43. 
Miner, Dr. Julius F.. on ovariotomy. 13. 
Minnesota State Medical Society, officers of. 420. 
Microscopic sections of eyes, 58. 
Missouri Medical .\ssociation, notice of, 334. 
Mitchell, Dr. C. L. , heart disease in pregnancy, 439. 
Modem giants, 429. 
Morbus coxarius. case of, 303. 

Morphia, poisoning by. 47. 372. 391 ; hypodermic injec- 
tions of, 225 ; and chloroform. 252. 
Moore, Prof. E. 31., on vowel and consonant sounds, 

49. 
Morris, Dr. Moreau, cerebro-spinal meningitis, 245. 



Index to Vol. VII. 



585 



Mortality of New York, extraordiuaiy, 332. 

Mother's Rcigister, notice of, 377. 

MoiTse's Ear, sensation in, 419. 

Munde, Dr. Paul, foreign letter from, 23G. 

Mud-baths, efficacy of, 3!)7. 

Murray, Dr. A, galvano-puncture needle (i'lustrrffcd)^ 

102, 4')1 ; intrauterine pessary (UUistrate.i), 319. 
Mushroams, edibie and poisonous, 369. 
Mydriasis, case of, 387. 
Myopia, tenotomy in, 64. 

N. 

Naeviis, cured by vaccination, 261 ; an extensive, 150; 
cured by electrolysis, 2!)4. 

Nails, growth of, as a means of prognosis, 108. 

Narceine, hydrochlorate, in hypodermic injections, 200. 

Nares, new method of plugging, 84. 

Narium, sejitum, abscess of, 28. 

Nasal douches, 64. 

Naso-pharyngeal tumors, 395, 578. 

National Medical Library, 202. 

Neck, cystic tumor of the, 418. 

Negro mortality at the South, 429. 

Needle Forceps, a new (iZ/nstrateii), 26, 

Nerves, regeneration of, 511. 

Newman, Dr. R. , electrolysis, 209 ; treatment of stric - 
ture. 270. 

News and Items, 48, 72, 93, 118, 166, 237, 264, 311, 333, 
359, 382, 408, 427, 478. 

New instruments, 117, 162, 213, 358, 402. 

New York Dispensaries, -statistics of, 431. 

New York Academy of Medicine, reports of, 6t), 115, 281 
305, 328, 474, 521, 546, 577. 

New York Hospital, the late, 229. 

New York Medico-Legal Society, officers of, 479. 

New York Pathological Society, reports of, 36, 111, 
15IJ, 295, 280, 30:5, 354, 451, 472, 517, 577. 

Nomenclature of diseases, report on, 179. 

Noyes, Dr. H. D. , relation of eye diseases with other dis- 
eases, 337. 

O. 

Obituary notices, 41, 162. 

Ob.stetric, report of section of American Medical Associa- 
tion, 189 ; report of practice, 390. 

Opium, use of the acute urasmia, 160 ; poisonous bella- 
donna in, 396 ; cultivation of in Tennessee, 526. 

Optic nerve, atrophy of, 313, 338 ; strychnia a stimvUus 
to, 32. 

Ophthalmia, purulent in new-born, 300. 

Ophthalmic arterj^ embolism of, 338. 

Ophthalmological congress, 383. 

Ophthalmology, notice of journal of, 327. 

Ophthalmoscope, review of work in uses of, 20. 

Ovariotomy, remarks on, 13, 189, 417, 430, 441, 512, M'i. 

Orbit, aneurism of, 419. 

Organic dynamics, 348. 

Os innominata, dislocation of, 105. 

Osteo-myelitis, cases of, 156. 

Otis, Dr. F. N., .sympathetic suppression of urine, 158. 

Otitis interna, division of, 151 ; media, 519. 

Otology, lectures on, 56. 

Our female brethren. 384. 

Ovary, cancer of, 394. 

Ovarian cyst, in a child aged eight years. 297; removal 
of during acute peritonitis, 512. 

Ovarian veins, thrombosis of, 305. 

Ozokerit in skin disease, 152. 

Oxygen in suffocation from coal gas, 419. 



Packard, Dr. C. W. , cerebo-spinal meningitis, 102. 

Pain, remarks on, 372. 

Painless parturition, 467. 

Painting, pathology of, 149. 

Pancreatic calculi, 356. 

Papilloma of larynx, 41 1. 

Palate, the, in health and disease, 359. 



Palpation in obstetrics, 416, 419. 

Paper dressing, 260. 

Paracentesis thoracis, 346. 

Paraffine, effects of on skin, 57. 

Paraplegia, mechanical treatment of {illustrated), 839. 

Parasites, review of work on, 146. 

Parisian hospitals. 383. 

Pathology, review of work on, 88. 

Pathological specimens, the keeping of, 526. 

Peasloe, Dr. E R., review of work by, 543. 

Peliosis rheumatica, 106. 

Pflvis, normal distortion of, 468. 

Peiisin, remarks on, 200. 329, 368, 477. 

Periuterine celluliiis, 393, 397. 

Perineum, supporting the. 391. 393. 

Peripheral placentitis, case of, 37. 

Peritonitis, acute in child, 281. 

Pessary, retained seventeen years, 45, 311 ; int ra-uterine 

galvanic, 319. 
Pessema, remarks on, 308, 403. 
Peters, Dr. J. C. , on quarantine, 68 ; perforation of 

pulmonary artery, 580. 
Peugnet, Dr. E., hypodermic injection of veratrum album, 

114 ; on veratrum viride, 121. 
Pharmacy, Board of, 285. 
Pharmacy Bill, remarks on the, 17, 64. 
Pharyngitis, 393. 

Philadelphia, reminiscences of, 170. 
Phosphoric acid lemonade, 331. 
Phosphorus poisoning, turpentine in, 58 ; experiments 

with, 235. 
Phthisis, aneurism as a cause of, 305. 
Physic, Watson's practice, notice of, 351. 
Physicians, duration of life of, 162. 
Physiological section of American Medical Association, 

report of, 191. 
Physiology, review of work on, 86, 362, 423. 
Piles, suppository for, 296 ; new forceps for, 26. 
Pills, a new excipient for, 216. 
Plaster Paris splints, 140, 150. 
Plastic apparatus in surgery, 389. 
Pleurisy, early blistering in, 297. 
Pleuritic effusion treated by thirst, 30. 
Pneumonia, early blistering in, 297 ; aconite in, 390. 
Poisoning, by hydrochloric acid, 84 ; large draughts of 

water in, 108 ; medical jurispi-udence of, 399. 
Polypi, excision of by hemp-saw, 149. 
Polyuria, case of, 394. 
Pooley, Dr. J. H., letter from, 310. 
Popliteal cyst, case of, 303. 
Population, increase of, 17 ; of globe, 543. 
Porter. Prof. Noah, notice of work by, 26. 
Post, Dr. A. C, mammary tumor, 112; impalement of 

bladder, 518. 
Post-mortem examinations, necessity for, 449. 
Precocious development, 120. 

Pregnancy, spurious, feigned and concealed, 225 ; sur- 
gical proceedings during, 369. 
Prepuce, follicular ulceration of, 114. 
Presbyterian Hospital, New York, 480. 
Professions, mortality, statistics of the, 311. 
Progress Medical Science, 27, 56, 83, 104, 197, 122, 251, 
^275, 296, 323, 343, 367, 389, 414, 441, 466, 540, 570, 

574. 
Protoplasm, action of galvanic cuiTcnt on, 284. 
Prout, Dr. J. S.. a new needle forceps {ilituitrated), 26. 
Pruritus vulvae, 298, 444. 
Psammonea, a case of, 354. 
Psoas abscess, 251. 

Public schools, sanitary condition of, 898. 
Puerperal convulsions, statistics, 335 ; treatment of, 393, 

466. 
Puerperal metritis, remarks on, 15. 
Puerperal thrombo.sis and embolism, 521. 
Pulmonary artery, perforation of, 580. 
Pulmonary consumption, 296. 
Purpura hemorrhagica, 451. 
Pus corpuscles, origin of, 252 ; uses of, 107. 



.586 



Index to Vol. VII. 



Pntnam, Dr. Mnry C, on pyiomia. 7:1 ; scnrliitinous 
npphritiH, •\'}i; anomalous heart. 111 ; intestinal ob- 
struction, 2lW. 

Pvfrmia in Rdlovup Hoxpital, 87H ; remarks on, 7:5. 

Q. 

','n ■ :i'.v ;ii.MinHt, 15.'). 

Qii:'.; tis. \. IN. ({(!. 

Oil ' . .- l:ir<^e (lijscs of, 223; in homicr.inia, 

li»-') ; tniniat« of, IIMI ; as parturient. I!i7, 27(i ; a 
>ubstituto for. 511 ; in uterine homorrhiif^e. oil. 

U. 

'■ • :.•-•», lOS. 

itLs. remarks on. 29, 200. 
......us and ulna, dislocation backward, 297; double 

fraoture of. .jS. 
Ilectal .speculum (illustrated), 363. 
Rectum, plu','trinjf the, 224 ; polypus of, 347 ; speculum 

for. 402 ; stricture treated by electrolysis, 209 ; 

traumatic hemorrhage of (illustrated), 301. 
Red coipusclos, mountinj,' of. 324. 
Respirator}- diseases, chronic diseases of, 199. 
Reviews and notiees of books. 19. 8(5, 110, 14(i, 203, 279. 

302. 327. 3") I. 377. 400. 423. 
Rhammis fraiigfular, value of. 329. 
Rheumatism, influence of on character, 345 ; treatment 

of. 414. 
Rhode Island Medical Society, notice of, 333. 
Rindfleisch. Dr. E . notice of work by. 88. 
Roberts. Dr. W. C, contagion of yellow fever, 474. 
Rodenstein, Dr. C. F.. cerebro-spinal meningitis. 71. 
Rogers. Dr. S., on a "/<j/womj»" profes.sion, 70. 117, 249. 
Rumex acetosa. poisoning by, 419. 
Ruralizing, the hygiene of. 349. 
Rush, Dr. Benjamin, recollections of, 170. 
Russian' quarantine, 479. 
Russel, C. P., small-pox statistics, 237. 
Rye-straw in conjunctiva, 392. 

S. 

Salaries of physicians, 96. 

Salt, value of. 48. 

Sand baths, 3(57. 

Sands, Dr. H. B. ; naso-pharyngeal tumor, etc., 578. 

San Francisco, mortality statistics of, 336. 

Sandringham. medical lessons from, 39. 

San Rafael, climate of the valley of, 134. 

Santonine. .substitute for. 57. 

Sarcoma of .shoulder. 578. 

Satterthwaite. Dr. T. E., and iron cross, 376. 

Saw, a folding (illustrated). 101. 

Saj-re. Dr. L. A. . and the order of Wasa, 286. ' 

Scapula, excision of. 417. 

Scarlatina, carbolic acid in. 299. 

Scarlatinous nephritis, case of. 354. 

Scarlet fever, prevention of, 299 ; treatment of, 466.^ 

Scirs, pathologj' of. ;>81. 

Schoeppe. acquittal of, 399. 

School, hygiene, 415. 

Sclerosis utari, remarks on. 15. 

Scorpion sting, treatment of. 413. 

Screaming fits, infantile, cause of, 208. 

Scrofulous anginae. diagnosis and treatment of. 30. 

Scrotum, instrument for amputation of (illustrated), 
161. 

Scurvy, only in males. 105, 240. 

Sea- sickness, prevention of, 4.56. 

Sea-water in London, 288. 

Seguin, Dr. E., notice of work by, 25 ; surface ther- 
mometry, 194 

Sewall. Dr. J. G.. cerebro-spinal meningitis, 265. 

Sewing-machines, use of. 59, 527. 

Sex of fcetus. prediction of. 417. 

Shoulder, new method for dislocation of, 52. 

Shrady, Dr. Geoi^e F., the drug-bill, etc.. 17, 18 ; the 
department of safety. 61 ; medical colleges. 85 ; 
hospital appointments, 109 ; graduation of improper 



person*. 153, 253 ; the Inw against quackery, 155 ; 
the late New York Hospital, 229 ; street cleaning, 
301 ; medical leHson.s of Stokes' trial, 325 ; the 
hygiene of ruralizing. 349 ; American Medical Asso- 
ciation, 376 ; sanitiry condition of our jmblic 
schools, 398 ; the .Medicnl RogiHter and the profes- 
sion, 421. 445 ; our relations to our female patients, 
4<i!> ; the farmingout Hystem for foundlings, 513. 

Sick headache, a reniedy for. 252. '299. 

Simpson. Sir J. Y. . review of work by, 146, 327. 

Skene. Dr. J. C, sclerosis uteri. 15. 

•Skin. nbsor]ition through. 252; grafting of, 572. 

Skin diseases, treatment of. 225. 22f», 370, 412. 

Skull, compound fracture of, 2!l'^. 

Small-pox. chnractors and treatment of, 95, 118, 142, 
KJO. 198, 23(i. 310. 365. 40.8. 419. 426. 432. 444, 456. 

Smith. Dr. A. H.. laryngeal mirror in jiosition. 358. 

Smith. Dr. Gouvemcur .M , on lactic acid, 329. 

Smith, Dr. J. L., notice of work by. 377 ; pathological 
specimens by, 36, 39, 451 . • 

Smith, Dr. O. H. cerebro-spinal meningitis, 268. 

Smith. Dr. S. , notice of work by, 353. 

Snake-bites, treatment of, 413. 

Snell, Dr A B., on American Medical Association, 426. 

Snuff, lead poisoning from. 56. 

Soap, brown Windsor, a<iulteration of, 287. 

Soda, silicate of in ferm3ntatiou, 511. 

Specialists, advertising, 376. 

Speculum, a new, 402. 

Speir, Dr. S. F., artery constrictor, 52, 150. 

Spermatic incontinence, 348. 

Spina bifida, cured, 3(i8. 

Spinal cord, changes in. from division of nerves, 252. 

Spine, notice of work on diseases of, 400. 

Squibb, Dr. E. R., on fa,shionable remedies, 328. 

St. Mary's Hospital, notice of, 359. 

St. Vincent's Hospital Report, 572. 

Starch bandages, modification of, 2(50. 

StatLstics, yearly, of New York Health Board, 333. 

Steatorrhoea tiavescens, 345. 

Sterility, 197. 

Stimson, Dr. L. A . letter from, 382. 

Stimulants, administration of, 370. 

Stokes?' trial, medical lessons of, 32-5. 

Strabismus, modern operation for, 97. 115. 

Stramonium, an antidote for opium poisoning, 44. 

Street-cleaning department, the new. 301. 

Strieker, Dr S. , review of work bv, 576. 

Stricture, the operations for. 113, 151, 270, 217, 477. 

Strychnia, hypodermicaliy, 348 ; tests for, 222. 

Studley. Dr. Mary J., on hospital appointment, 212. 

Sugar-coated pills, value of. 329. 

Sulphate of iron in suppuration, 104. 

Sulphur fumigations in variola, 300. 

Sulphurous acid in sj-philitic ulceration. 105. 

Sunstroke, notice of work on, 424 ; quinine in, 360. 

Sun. physical characters of the. 417. 

Suppression of urine, the result of injury to urethra, 
158. 

Surgical Section of American Medical Association, re- 
port of, 192. 254. 

Surgery, review of works on practice of, 24, 352. 

Suspension apparatus, the. 256. 

Sutures, none after removal of breast, 276. 

Syme's amputation, utility of. 156. 

Sympathetic nerve, individuality of, 392. 

Syncope, death from. 1505. 

Syphilis, blood in, 27. 83. 345. 415 ; character and treat- 
ment of. 167. 298. 305. 346 ; aggravated form of, 528. 

Syria, contagious diseases in, 359. 



Talmudic gleanings, 408. 

Tanacetic acid as sub.>titute for santonine, 57. 

Tannin packing in prolapsus uteri, 342. 

Tape-worm, in child three years, 107. 

Tar, to remove, 415. 

Tarantula bite, treatment of, 413. 



Index to Vol. VII. 



587 



Temperauce in France, 428. 

Teetli, replantation of, 149, 3;")2 ; exercise of, 468. 

Tetanus, treatment of among Chinese, 228 ; treatment 

of by excision, and chloral, 108, 299. 
Tetanus cured by excision of nerve, 108. 
Thapsia as a rubefacient, 106. 
Theomania, 872. 

Thermometers, medical, the best, 380. 
Thermometry, clinical remarks on, 90, 359 ; notice of 

work on, 2;'). 
Thigh, amputation of, 234. 
Thomson, Dr. W. H. , on psammonea, 354. 
Thorax, impalement of, 198. 
Throat, notice of work on diseases of, 400. 
Thrombosis of tibial artery, 156; puerperal, 521. 
Tibia, reproduction of, 31(>. 
Tic-douloureux, 296 ; by galvanism, 442. 
Tonsillotomes, 2()1. 

Tonsils, hypertrophied, treatment of, 367. 
Tooth, fracture of, aud union of, 468. 
Tractea, stricture, a case of. 234. 
Tracheo- bronchitis, pseudo, 39. 
Tracheotomy, cases of, 12, 414. 

Transaotiens of American Ophthalmological Society, 19. 
Transfusion, cases of, 236, 324. 
Trephining over lateral sinus, 222 ; case of, 577. 
Triplets, case of, 428. 
Trismus nascentium, case of, 343. 
Trueheart. Dr. C W. , on conjunctivitis, 569. 
Turnbull, Dr. L., review of work on diseases of, 19. 
Tuberculosis following bronchial catarrh, 36. 
Tumors, injections for, 235. 
Tyndale, Dr. J. H. , vaccination during the fever stage of 

variola, 10. 
Typhoid fever, similarity with ovaritis, 106; treatment 

of, 199, 233,465, 444. 
Typhus, quarantine of, 8. 

U. 

Ulcers, sloughing, iodide of starch for, 105. 

Ulster County Medical Society, 333. 

Unscrupulous criticism. 212. 

United States Marine Hospital Service, 94, 185. 

University of Pacific Medical Department, 249. 

University of Pennsylvania, notice of, 383. 

Urajmia, acute, use of opium in, 160. 

Uranoplasty, 192. 

Urethra prolapsus, 299 ; rupture of, 290 ; surgery of the, 
217; anatomy of, 235 ; hemorrhoids of, 381, 511. 

Urethral baths, 60. 

Urinary calculi in China, 44. 

Urinary diseases, review of work on, 302. 

Urine, diabetic, 351 ; indican in, 345 ; in malarial hemi- 
turia, 197; retention of, 149, 291, 433. 

Uteri, cervix, amputation of, 275. 

Uterine, cloth-tents, 57 ; hemorrhage, quinine in, 511 ; 
anomaly, 151 ; sound, 224, 352 ; tumor, 397. 

Uteru.q, sclerosis of, 15 ; double, 528 ; removal of inverted, 
200 ; fibrous, hypodermically treated by ergot, 344 ; 
tannin packing in, 342 ; the surgery of, 344 ; foetal 
femur embedded in, 443 ; unique case of inversion of, 
443; prolapsus of gravid, 444; inverted, 513; re- 
moval of, 510 ; cancer of, 512. 



V. 

Vaccine virus, 296. 

Vaccination during fever-stage of variola, 10 ; remarks 

on, 65, 11,7, 298, 396, 398, 444,467, 468. 
Vagina, membranous ca.st of, 40. 
Vaginal injections, warm, iise of, 100. 
Vanderpoel, Dr. S. Oakley, on yellow fever, 563. 
Vanilla ices, poisoning by, 149, 391. 
Varicocele, radical cure of, 416. 
Variola, character and treatment of, 10, 28, 40, 190, 326, 

347, 371. 
Varix, injection of ergotin in, 236. 
Vaso motor physiology, 190. 
Venereal sores, cauterizing, 151. 
Veratroida, experiments with, 128. 
Veratrum al))um, hypodermic injection of, 114; proper- 

• ties of, 121. 
Veratrum viride, properties of, 121, 468. 
Vienna, Medical Department of University of, 44. 
Vol. VII. close of, 575. 
Vomiting of pregnancy. 93. 
Voridia, experiments with, 129. 
Vowel sounds, production of, 49. 

W. 

Walser, Dr. Theodore, on quarantine, 1. 

Warner, Dr. John W., a case of intussusception, 530. 

Washington delegates, the excluded, 182. 

Waterman, Dr S. , on blood crystals, 212. 

Water, vital importance of pure, 239. 

Watson, Sir Thomas, work by, 351. 

Webster, Dr. David, reports of Manhattan Eye and Ear 
Hospital, 144. 

Westchester County Medical Society, notice of, 333. 

Wharton trial, the, 360. 

Whitehead's, Dr. W. R., gag, 358, 403. 

Whithall, Dr, S. , cerebro- spinal meningitis, 200; medi- 
cal thermometry, 380. 

Whooping-cough, cause of, 298 ; a remedy for, 335, 

Williams, Dr. C. J. B., on pulmonary consumption, 23. 

Wisconsin State Medical Society, notice of, 288. 

Woman question, 174, 187 ; difference between man and 
woman, 382. 

Women's Medical College, 315. 

Women, notice of work on diseases of, 147, 327, 377. 

Worms, notice of work on, 471. 

Wounds, isolating dressing of, 336. 

Wood, Dr. H. C, Jr., notice of work by, 424. 

Wrist, dislocation of, 296, 408 ; extension in diseases of 
(ilhistrated), 143. 

Wunderlich, Dr. C. A., notice of work by, 25. 

Wymau, Dr. M. , notice of work by, 378. 



Xylol, remarks on, 20, 329, 347. 

Y. 

Tear Book of Therapeutics, notice of, 470. 

Yellow fever, quarantine of, 4; contagion of, 474; pa 

thology and treatment of, 38 ; history of, on JVuman- 

cia, 562. 



CONTRIBUTORS TO VOLUME VII. 



Bailey, Dr. James S., Aloany, N. Y. 

Baukkr, Dr. B. Fordyck, Prof. Clinical Obstetrics, 

Bellevue Hospital Medical College, New York. 
Battey, Dr. R., Rome, Georgia. 

Beach, Dr. Wooster, Jr., Deputy Coroner, New York- 
Beard, Dr. G. M., New York. 
Bell, Dr. A. N., Brooklyn, New York. 
Bennett, Dr. E. P., Danbury, Conn. 
Bennett, Dr. W. H., New York. 
Briddon, Dr. C. K., New York. 
Brockw.^y, Dr. A. Norton, Harlem, N. Y. 
Bronson, Dr. E. B., New York. 
Buck, Dr. Albert H., New York. 
Buck, Dr. Gurdon, Surgeon to New York and St. 

Luke's Hospitals, New York. 
Bull, Dr. Charles S., New York. 
Bumstead, Prof. Freeman J., New York. 
Bunker, Dr. E. S., Brooklyn, N. Y. 
Burrall, Dr. F. A., New York. 
Byrne, Dr. J., Brooklyn, N. Y. 

Caro, Dr. Salvatore, New York. 
Castle, Dr. F. A., New York. 
Chamberlain, Dr. W. M., New York. 
Clarke, Dr. H. K., Geneva, N. Y. 
Cohen, Dr. J. Solis, Philadelphia, Pa. 
Cruse, Dr. Thomas K., New York. 

De Marmon, Dr. Ph., King's Bridge, N. Y. 
Derby, Dr. H., New York. 
DoNNELY, Dr. M., N. Y. 

Dowell. Prof Greenville, M.D., Galveston, Texas. 
Dubois, Dr. H A., San Rafael, Cal. 
DuFFiELD, Dr. Edward, Hannibal, Mo. 
Dunning, Dr. W. B., Bellevue Hospital, N. Y. 
DwYER, Dr. John, Ward's Island Emigrant Hospital, 
N. Y. 

FixNELL, Dr. T. C, New York. 
Flint, Prof. Austin, New York. 
FoRTUN, Dr. C. A., Charity Hospital, N. Y. 
Frisbie, Dr. C. W., East Springfield, N. Y. 

GouLEY, Prof J. W. S., M.D., New York. 

Hamilton, Dr. Frank H., Prof Fractures and Disloca- 
tions, and Military Surgery, Bellevue Hospital 
Medical College, New York, etc. 

Hayes, Dr. R. T., Yokohama, Japan. 

Henry, Dr. M". H., Ed. Journal SypMhgraplxy and Der- 
matohgy^ New York. 

Hewit, Dr. H. S., New York. 

Hudson, Dr. E. D., New York. 



Hunter, Dr. W. C, New York. 
Hutchison, Dr. JosErn C, Brooklyn, N. Y. 

Jacobi, Dr. A., Prof Infantile Diseases, College of Phy- 
sicians and Surgeons, New York. 
Janeway, Dr. E. G., New York. 

Knapp, Prof H., M.D. flate of Heidelberg), New York. 

Leaming, Prof James R., iM.D., New York. 

Lewis, Dr. Z. Edwards, West Farms, N. Y. 

LiDELL, Dr. John A., New York. 

Lincoln, Dr. R. S., New York. 

Loomis, a. L., M.D., Prof of Theory and Practice of 

Medicine, New York University, New York. 
Loring, Dr. E. G., New York. 

Macdonald. Dr. A. E., Small-pox Hospital, New York. 

Mann, Dr. Edward C, Brooklyn, N. Y. 

Mason, Prof Erskine, M.D., New York. 

Mathewson, Dr. A., Brooklyn, N. Y. 

Miller, Dr. M. N., New York. 

Miner, Dr. Julius F., Buffalo, N. Y. 

Mitchell, Dr. C. L., Brooklyn, N. Y. 

Moore, Prof E. M., Rochester, N. Y. 

Morris, Dr. Moreau, San. Sup. Health Dept., New York. 

Munde, Dr. Paul, Florence, Mass. 

Murray, Dr. Alex., New York. 

Newman, Dr. Robert, New York. 
NoYES, Prof H. D., New York. 

Packard, Dr. C. W., New York. 

Pardee, Prof Charles Inslee, M.D., New York. 

Peters, Dr. John C, New York. 

Peugnet, Dr. E., New York. 

Pomeroy, Dr. 0. D., New York. 

PooLEY, Dr. J. H., Yonkers, N. Y. 

Post, Prof Alfred C, Beirut, Syria. 

Prout, Dr. J. S., Brooklyn, N. Y. 

Putnam, Dr. Mary C, New York. 

Roberts, Dr. W. C, New York. 
Rockwell, Dr. A. D., New York. 
Rogers, Dr. Stephen, New York. 
EossE, Dr. Irving C, U. S. Army. 
RussEL, Dr. Chas. P., Registrar Records, Health Dept., 
New York. 

Sands, Prof H. B., New York. 
Satterthwaite, Dr. Thomas E., New York. 
Seguin, Dr. E., New York. 
Sew ALL, Dr. J. G., New York. 
Skene, Dr. J. C, New York. 



Contributors to Vol. VII. 



Smith, Dr. OorvKnNKi'K M., New York. 
Smith, Prof. J. Lkwis, New York. 
Smith, Dr. T. Blajjch, Nyack, N. Y. 
Spkir, Dr. S. Flkkt, Hrooklyn, N. Y. 
Stiuson, L. a., P.iris, Frftiice. 
Sri-DLEY, Dr. Mahv J., Elizabeth, N. J. 

Thomas. Piof. T. rfAii.i.AiiD, M.D., New York. 
InnMrsos, Dr. ItHAPKoitn S., New York. 
TiUKMEAur, Dr. C. W., Gnlveaton, Texas. 
Ty.vdalk, Dr. J. II., German Ilospiial, New York. 

Van Geison, Dr. R. E., Greenpoinf, N. Y. 
VAXDERroEL, Dr. S. Oaki.ey, Quarantine, N. Y. 

"Walser, Dr. Theodore, SUten Islanil, X. Y. 

Watekma.n, Dr. S., New York. 

Webster, Dr. D., ^[anliattan Eye and Ear Ilospilal, 

Nl'W York, 
"West, Dr. II. S., Sivaa, Turkey. 
"White, Dr. Francis V., New York. 
WniTEHEAP, Dr. W. R., M.D., New York. 
WniTTAL, Dr. S. G., New York. 
WiNSLOw, Dr, John, New York. 



Societies and Institutions from which Rfports have been 
furnished. 

A.MKRICAN Medical Association. 

American Otoi-ooicai, Society. 

Beli.evue no.spiTAL, Nt-w York. 

Bellevue IIo.sriTAi, Medical College, New York. 

CiiAuiTY Hospital, Blackw(.ll'.s Island, N. Y. 

College Physicians and Surgeons, New York. 

German Hospital, New York. 

LoNQ Island College Hospital, Brooklyn, N. Y. 

Manhattan Eye and Ear Hospital, New York. 

Medical Library and Journal Association, New 

York. 
Medical Society, County of Kings, N. Y. 
Medical Society of the County of New York, 
Medical Society of the State of New York. 
New York Academy of Medicine, New Yorlc. 
New York Pathological Society. 
Presbyterian Hospital, New York. 
Roosevelt Hospital, New York. 
St. Mary's Hospital. Brooklyn, N. Y. 
St. Vincent's Hospital, N. Y. 
University Medical College. 
St. Vincents Hospital. New York. 



CO. 




E Medical Record 

21 ^cnii-illoutljli) Journal of iUctiiciiic aiitr ^nt^cx^. 



Vol. VIL] 



New Yokk, Maticii 1, 1872. 



[No. 1. 



©rigiital Communications. 

QUARANTINE REGULATIONS. 
By THEODORE WALSER, M.D., 

OF NEW BlilGHTON, STATEN ISLAND, N. Y. 

Read at a Stated Meeting of the New York Academy of Medicine, Febru- 
ary 1, 1872. 

In considering the quesdon of Quarantine, I am con- 
scious I am addressing the elite of the medical profes- 
sion — men familiar ^vith the literature, aetiology, and 
modus propagandi of every disease that comes under 
its provisions ; and I shall limit my observations, there- 
fore, to personal experience on a field which is compa- 
ratively foreign to the student of Hygiene, and in treat- 
ing the history of epidemics in New York City, merely 
refer to them as the causes Avhich prompted the fram- 
ing of new laws and the initiation of further quarantine 
restrictions. Tou will be pleased, therefore, to bear 
with me if I speak of these hws as an integral part of 
the question before us, and, in summing up the experi- 
ence of canturies, make this experience the basis on 
which to decide the claims of quarantine. 

Appalled by the gradual approach of the epidemics 
of yellow-fever, which had caused such fearful devasta- 
tion in Charleston and Norfolk during previous years, 
the first quarantine laws were enacted in the colony of 
New York by the Lieut.-Governor, Council, and General 
Assembly in 1758, enacting that " all trading-vessels, 
transports, and others, having small-pox, yellow-fever, 
or other contagious distempers on board ; and all per- 
sons, merchandise, and goods whatsoever, coming or 
imported in such vessels; and all vessels coming from 
any place infected with distempers, shall not come into 
any of the ports or harbors of this city, or nearer to it 
than the land commonly called Bedloe's Island, and shall 
be obliged to make quarantine there, or in such other 
place or places, for such time and in such manner as 
the Governor, or Commander-in-chief, by and with the 
advice of His Majesty's Council, shall deem proper and 
reasonable to direct and appoint ; and until such persons, 
goods, or merchandise shall have respectively performed, 
and be discharged from, such quarantine, no such per- 
sons, goods, or merchandise, or any of them, shall come, 
or be brought ashore, unloaded, go, or be put on board 
of any vessel within this colony, or the neigliboring colo- 
ny of New Jersey, unless they shall first be permitted 
and licensed by order of the Governor or Commander- 
in-Chief for the time being, by and with the consent 
of the Council ; " making the penalty of infiingement of 
this Unv £200, and £20 if any infected person Avas 
found on board of any vessel without due notice, or if 
any pilot refused or neglected to obey the provisions 
of this law. 

Whatever may have been the preventive course pur- 
sued, no epidemic or disease of any alarming character 
occurred in New York from this date, although Dr. 
Chisholm remarks, " that the smell from the ships was 



in the highest degree offensive, and the police at that 
time by no means efficient, and putrid substances of 
every description were accumulated in the siiips and 
every part of the city." 

In 1784 it was enacted in the Senate and Assembly, 
that all vessels having on board any persons infected 
with yellow-fever, or any other contagious distemper, 
or coming from any place infected with such conta- 
gious distemper, shall not come into the harbor or city 
lower than Bedloe's Island, and shall perform quaran- 
tine there for such time and in such a manner as tlie 
Governor, or, in his absence, the Mayor of the City, 
may direct ; and that during such quarantine no person, 
goods, or merchandise shall be permitted to leave the 
vessel without the permit of the Governor, or Mayor, 
of New York. The law further defines the duties of 
masters and pilots, applies the penalty exacted, as be- 
fore, for the benefit of the hf;hthouse at Sandy-liook, 
invests the Governor with the right of appointing a 
physician, and specifies his duties, privileges, and com- 
pensation. 

Yellow-fever prevailed in New York after this to 
a greater or less extent every year. Of the epidemics 
of 1791 and 1703 no further account is given than 
merely stating the number of its victims, and the lo- 
calities, streets, and wdiarves where it prevailed. Its 
origin in 1795 is, however, clearly traced to the brig 
Zephyr from the West Indies ; Dr. Treat, the examin- 
ing surgeon, being its first victim — as is supposed from 
making an autopsy of a death on board on the day of 
her arrival in port. Being permitted to go to the wharf, 
foot of Dover street, she hauled alongside the ship 117/- 
liarns from Liverpool, where the disease first appeared 
among the crew, and a few days later in White near 
Dover street, extending thence to the adjacent build- 
ings and streets. Every effort was made by Dr. BaiJy 
to contradict this statement ; using as the strength of 
his argument that no one of Dr. Treat's attendants and 
friends was taken sick, and hence it could not have 
been the yellow-fever. Indeed, the idea of personal 
infection had so overshadowed the intellect of the 
profession, that the most important facts were over- 
looked in the vain search of evidence for it. In 
the mean time the TIankey brought the disease from 
the coast of Africa to New Granada, arriving on the 
18th of March. In the middle of April the disease as- 
sumed an epidemic form on the Island ; during June 
and July it swept over the entire Island. Erom New 
Granada it was carried to St. Domingo and Jamaica, 
and thence to Philadelphia, by clothes, and more es- 
pecially the woollen jackets, of diseased sailors. "Ves- 
sels from Philadelphia Avere now quarantined in New 
York. 

In 1796 the first Health Oflicer and seven Commis- 
sioners of Health were appointed, and their duties de- 
fined. All vessels wMth forty or more passengers from 
any foreign port were made subject to quarantine ; 
the Governor of the State was authorized to issue 
from time to time proclamations designating the ports 
from which vessels should be quarantined, and the Health 
Officer or Health Commissioners were authorized to bring 
vessels already at the wharf back to quarantine, and to 



TILE MEDICAL RECOKD. 



anchor wheresoever they might direct. £2,000 were 
nppropriatetl to orcct a Lazaretto on Governor's Island 
for the reception of infectious diseases, and placed under 
the charge of the Health Ofliccr, and a further sum of 
£2,000 was iipproj)riated for its maintenance. It was 
then maile oblii,'atory upon every practisin-,' physician 
to report I'ach case of infectious and contagious disease 
10 the lleallli Commissioners. 

liy the laws enacted in 1798 the apppointment of 
Health Ollicer and Commissioners of Health, and their 
respective duties, were still further defined ; all vessels 
having or liaving had on board any case of lever, or 
coming from a port where such fever prevailed, being 
made subject to quaraniine, unless they had been pre- 
viously in any of our northern ports for a period exceed- 
ing ten days. 

Dr. I'nderhill gives the following account respecting 
the epidemic of yellow-fever which followed in the same 
year:— 

" Some time in July the ship Fame is said to have 
arrived from one of the West Indian islands, and come 
to the wliarf below New Slip, where she lay for some 
lime. About the tliird or fourth of August some people 
went to discharge her ballast and to pump her out. 
Among the ballast was a quantity of damaged coffee, 
extremely putrid, which, with the water discharged 
from the pump, was so oUensive to the smell tliat the 
neiglibors were induced to shut their windows, espe- 
cially while eating. About the sixth of the month, a 
party dined at the house of a Mr. Mead in the neighbor- 
hood, all of whom were taken sick in their respective 
residences, on the fifth day afterwards, of yellow-fever, 
and several of them died. The next house above was 
visited in the same way ; three of the inmates were 
t^ken sick at the same time, two of whom died. In the 
second and third houses the inmates shared the same 
fate." The number of deaths from yellow-fever during 
this epidemic exceeded 2,000; wbilein Philadelphia the 
ravages of the disease were still greater, and, as in New 
York iu the case of the ship Fame, were clearly to be 
traced to the Deborah and Mary from the Spanish Main. 

Ajipalled and now full}' conscious of the danger, and 
looking to an efficient quarantine as the only safeguard 
against its importation, in 1790 the healtli laws were 
so amended as to constitute the Health Officer Resi- 
dent Physician, and members of the Council the Com- 
missioners of Health, with the power to purchase a 
tract of land on Staien Island for a boarding station 
and marine hospital. The eastern shore was selected, 
and some of the buildings were occupied during the 
autumn. The list of ports from which ve.-selswere sub- 
ject to quarantine embraced now all foreign and do- 
mestic ports south of Georgia, from the 31st of May to 
the 1st of October. In 1799, while the authorities were 
still groping in gutter;, and sinks for the origin of the 
disease, we find that seventy-four ca.ses of yellow-fever 
were sent from the city to the Marine Hospital, the dis- 
ease being confined to Old Slip and the vicinity of the 
East Iliver. 

In 1801 the Health Officer, Health Commissioners, 
and Resident Physician to the Marine Hospital were 
constituted the Board of Health of New York, and for 
the first time the introduction of cargoes and nifrchan- 
dise from infected vessels into the city of New York 
was prohibited. Cargoes from infected ports had to be 
discharged by lighters, and the vessel cleaned and 
fumigated before pratique could be granted. Over 
seven hundred cases of ship-fever were admitted dur- 
ing the same year, comprising among the number over 
one-third of the pa.ssengers of a brig from Sligo, arriv- 
ing at this port after a long passage, in a destitute and 
almost starvinsr condition. 



In 1803, out of 1,G00 cases GOO died of yellow-fever, 
commencing in coflTee-honse .slip and its vicinity. The 
source is not given l^y any existing record. Nor can 
the epidemic of 1805 be traced to positive infection 
and importation of any one vessel; and to attribute it 
to the landing of a quantity of rags from Leghorn is 
perhaps as eironcous as the as-sertion of the Health 
Officer, that it did not ari.se from any neglect at qua- 
rantine, or come through that channel. The law pa.?.sed 
in L'-'Ol, providing that no vessel from infected ports 
should approach nearer the city than three hundred 
yards, seems tiien to have been a dead letter. 

In 1811 the quarantine laws were revised, and vessels 
from Asia, Africa, and the Mediterranean, and from any 
port south of Georgia, the Bernuidas, Bahamas, and 
the West Indies, and all others having forty or more 
passengers on board, or having had sickness or death 
while in jiort or on the passage, were made subject to 
quarantine during the year; and all vessels from Am- 
erican ports south of Cape Henry were made subject 
to it from the 30th of May to the 1st of October. Ves- 
s.'ls with yellow-fever or any other pestilential disease 
onboard, or hailing from ports where yellow-fever pre- 
vailed, wore to be unloaded at quarantine, cleaned and 
whitewashed three times, and to remain at least thirty 
days in quarantine. No passenger or sailor was per- 
mitted to proceed to New York until twenty days after 
the occurrence of the la«t case of pestilential di.sease. 
Vessels from the West Indies, Africa, and South of 
Georgia were to remain but four days at quarantine 'to 
discharge tlieir cargoes by lighters, and under no cir- 
cumstances approach nearer the city than three hun- 
dred yards ; and crafs considered to be dangerous to be 
removed from the city to the quarantine grounds; car- 
goes of hides, wool, and cotton to be landed at the 
public stores at quarantine. 

New York remained exempt from the visitation of 
any contagious disease during the war Avith England 
and until 1819. when a few cases of yellow-fever occur- 
red near Old Slip; but by the vigorous exertions of the 
Board of Health and the blessing of divine Providence, 
its spread was averted. 

In July, 1822, the first case of yellow-fever occurred 
at the foot of Rector street, attributed to cargoes landed 
from the Sjjanish Soldier and the Eliza- Jane from 
Havana, although, as usual, its source was sought 
in churchyards, gutters, and sinks. A fact not to be 
overlooked is, however, that the same vessel which car- 
ried yellow-fever from Key West to St. Augustine, and 
was the prolific source of the epidemic in St. Augustine, 
was overhauled at the foot of Rector street, and two of 
the employes, and five who visited them, were among 
the first victims of the disease. Of five hundred who 
had the disease in this year, two hundred and fifty-five 
died. With this terminated the last of the yellow- fever 
epidemics, occurring during a period of more than half 
a century. 

The quarantine laws, as last amended, remained near- 
ly the same until 1830, when an act was passed, 
permitting healthy persons arriving in vessels from 
infected ports to proceed to the city, but without bag- 
gage. 

In August, 1831, the Board of Health were first con- 
vened to consider the quarantine of cholera, and a com- 
mission was appointed to confer with the President, 
and to memorialize Congress to institute a national 
quarantine, and aid the authorities of New York in 
protecting the public against the dreaded visitation of 
cholera. In response, a communication was received 
from the General Government, surrendering the use of 
Fort Lafayette as a depot for goods. A resolution was 
adopted to land all goods from Russia at the Fort. To 



THE MEDICAL RECORD. 



Ibis was added, at a later meeting, all merchandise from 
Hamburg and Smyrna. 

In January, 1832, tbe appointment of a sanitary com- 
mission under the auspices of the Greneral Government 
was solicited, whose duty it should be either to send 
some of their own members or other agents to the ports 
of Europe or Asin, where the disease prevailed, and to 
collect facts relating to the means of prevention, and 
remedies to be applied in cases of the disease. In April 
and June further preventive laws were enacted, and 
§500 were applied to the purchase of chloride of lime. 
On the 2d of July twelve cases were first reported to 
the Board of Health, and a proclamation was issued, 
assuring the public that the disease was not personally 
communicable. By the 18th of July the number of 
deaths from cholera exceeded six hundred. Tiie chole- 
ra epidemic of 1832 first appeared in Quebec. A law 
subjecting to quarantine regulations all vessels from 
ports of Upper and Lower Canada was passed in 1833, 
and has remained in force until the present day. 

In 1845 a commission was appointed to revise the 
quarantine laws, but without any special result. 

In 184S a number of infected vessels, government 
transports from New Orleans and ^lexico, were anchored 
oflF the old quarantine grounds. After an easterly 
wind, a quantity of refuse material from these vessels 
drifted ashore, lodging in Stapleton Basin. In less 
than a week following, two cases of yellow-fever oc- 
curred in the nearest dweUing, and then extended to 
the adjacent dwellings, and prevailed as an epidemic 
for half a mile along the shore. Visitors and nurses 
were attacked ; but returning to their own homes in the 
interior, the disease remained confined to themselves-, 
although surrounded by their families, and in localities 
much more favorable to the generation and develop- 
ment of miasmatic or contagious diseases than the 
place where they became infected. 

In 1849 §50,000 was appropriated, and a committee ap- 
pointed to efi'ect a removal of quarantine to Sandy Hook. 

In 1855, the year of the memorable epidemic of 
yellow-fever in Norfolk, Va., New York remained ex- 
empt from a visitation of the disease, and but few cases 
were admitted from shipboard. 

In 1856 the quarantine laAvs were again revised; 
new and special power was granted to the Health Offi- 
cer, and by an adroit transposition of the figure 3, the 
coastwise quarantine was extended from the 1st of 
April to the 31st of October, instead of from the 30th 
of April to the 1st of October; and after the different 
ports of the West Indies, Mediterranean, and coast of 
Africa, from which vessels were subject to quarantine, 
"all other ports" were sandwiched in, by which the 
Health Officer's income was increased from $6,000 to 
$10,000 per annum. 

The epidemic prevalence of yellow-fever at Fort Ham- 
ilton, on the shores of Staten Island, and on Governor's 
Island, during this year, has been so ably and recently 
described by Dr. Harris, that I need not refer to it. 

In 1858 the quarantine hospitals were destroyed, 
and then an entire change of quarantine regulations 
was initiated. The Commissioners of Emigration, the 
legal custodians of the quarantine hospitals, were super- 
seded by Quarantine Commissioners in 1859, and §50,000 
were appropriated to defray their expenses. The 
"Floating Hospital," constructed from the hulk of an 
old ocean steamer, was anchored in the Lower Bay 
for the reception of yellow-fever patients, and as a 
boarding station for the c^uarantine of vessels from the 
West Indies, coast of Africa, and American ports south 
of Georgia. 

In 1861 an additional appropriation of §43,000 was 
made, and — 



In 18G3 the quarantine laws were so revised as to 
give the Health Otticer additional powers, even to the 
destruction of cargoes and the submersion of vessels. 
The employ6s, stevedores, and lightermen were to be 
selected by him, but their compensation was fixed by the 
Commissioners of Quarantine, who were also by this 
act constituted a Board of Appeal. 

In 1864 a further sum of §80,000 was appropriated. 

In 1865 the quarantine laws were again revised, 
but without making any material change; $49,000 ad- 
ditional were appropriated. 

In 1866 the Mayors of New York and Brooklyn, in 
conjunction with the Commissioners of Quarantine, 
Avere empowered to construct permanent quarantine 
buildings in the Lower Bay, and §400,000 appropriated 
fur that purpose. The sale of the old quarantine 
grounds, with the exception of a boarding station, was 
ordered, and, by concurrent resolutions, the general 
government petitioned for hulks and vessels for tem- 
porary quarantine purposes. 

In 1867, besides further appropriations of §132,000, 
temporary accommodations for the reception of passen- 
gers under quarantine were ordered to be made on 
" Barren Island," and the west end of Coney Island 
selected for a boarding station; but during the follow- 
ing session in '68 this law was again repealed, and no 
further enactments passed by which the quarantine reg- 
ulations were materially modified. 

Over §300,000 have sinc3 that time been appropriated 
for the maintenance of quarantine and the construction 
of buildings on the island in the Lower Bay. under 
the law of 1866 ; only the lower one is prepared to re- 
ceive patients, while the upper one remains unfinished, 
and may come "handy." but is certainly erected with- 
out special design or purpose. 

In reviewing the history of quarantine, and the 
various laws enacted to protect the community from 
the introduction and prevalence of contagious diseases, 
we find that every progressive measure was prompted 
, by a sense of the insufficiency and insecurity under ex- 
isting laws, and the modification and change of medi- 
cal opinion in regard to the mode of emanation and 
i propagation of the disease. The quarantine had been 
removed from Governor's and Bedloe's to Staten 
1 Island, and each one in its turn abandoned. At first 
it was only intended to protect against yellow-fever 
I and small-pox. The swelhng tide of emigration, and 
the prevalence of typhus amongst the masses, intro- 
duced the last-named disease as the most prominent 
danger to be guarded against. Then cholera, appalling 
and tearful in its destructive march over the continent, 
called for new and energetic measures of self- protection. 
And so, patch upon patch was added, meeting each 
I contingency, and providing for ever}^ successive emer- 
gencies ; each disease in its turn engaging the attention 
I of law and medicine, as the danger from its ravage.? 
I appeared more imminent. The range of ports from 
' which vessels were subject to quarantine was gradually 
! extended, until it finally included all vessels from all 
foreign ports, and all coastwise vessels from domestic 
ports south of Cape Henlopen, from the 1st of April to 
the 31st of October. 

Before we consider the mode of propagation and the 
quarantine of each disease, permit me first to cast a 
glance upon the topography of port? from which ves- 
sels were subject to quarantine in the harbor of New 
York. I have already mentioned how strangely and 
surreptitiously " all other ports" have been smuggled in 
under the laws of 1856. What are the diseases which 
possibly can excuse a quarantine of merchant, vessels 
, from any of our northern ports ? Why are vessels from 
i Nova Scotia subject to sanitary restric; ions from which 



THE MEDICAL RECORD. 



Maine is exempt? and liow is it that vessels coming 
iliruufrh llu' sound ni;iy and do onlfr New York 
Harbor at all seasons, while vessels puissinp to llio east- 
ward of LoDfj Island are subject to visitation ? Are 
tliere any professional frrounds whatever justifying 
this restriction or infringement on conuneree? The 
same may be said of merchantmen from the west of 
Kuropc, whid), prior to this interlineation, were not 
subject to quarantine nnless having passengers on 
board. And yet only a slight, a very slight diancc 
exists of disea<e |)revailing in their ports of Qi|)arturc 
of which we will not have been apprised; for at an 
age when we have daily communication with all the 
world, this can scarcely happen. What can warrant a 
(piarantinc from the Potomac, from WashingtuM and 
Haltimore, whi h does not apply equallj' well to I'hila- 
(ielpliia? During thirteen years' service in quarantine, 
1 know of only one instance of sickness coming from 
any of these vessel.^, and that was a passenger from the 
interior. Fruits and vegetables, oysters and coal from 
A'irginia, are certainly cargoes which require no quar- 
antine, and I mention this because every quarantine 
restriction is supposed to rest on medical ground. 



YELLOW-FEVER. 



The history of yellow-fever has been so thorougldy 
interwoven, and was in fact so much the originating 
cause of quarantine, that it is not my intention to occupy 
your time with the recital of a subject so familiar to all 
present, but at once proceed to the consideration of 
quarantine regulations respecting this disease in the 
port of New York, studiously endeavoring to limit my 
remarks to the professional merits of the question. 

As an cllicient quarantine can only be based upon a 
thorougii knowledge of the modus propagandi of the dis- 
ease, and as this can be our only safe guide between 
inefliciencv on the one side, and unwarrantable exaction 
and restrictions on commerce and intercourse on the 
otlier, I must invite your attention to the consideration 
of the 

I. Xature and characteristics, 
II. Meaiui and mode of portation, 

III. Mode of infection in yello"\v-fever, and 

IV. T/ie quarantine reyulaiions now in use. and neces- 
sary to prevent the introduction and prevalence of this 
disease in the port of New York. 

I. Character and Xatin-e of Yellow-Fever. — As long 
as we are unable tangibly or ocularly to demonstrate the 
biopla.«ma, or disease germ, or actually know what con- 
stitutes the morbific cause of the disease, we must con- 
tent ourselves in its conception with analogy and infer- 
ence, and by this we are unmistakably led to believe 
that the yellow-fever virus is of cryptogamic origin. 
This theory assumes practical form when we consider 
the chemical action of fungi of all kinds upon the 
air; their subsequent deleterious influence upon animal 
life; and the conditions of their generation and growth 
— heat, moisture, and darkness, with their corresponding 
meansof extermination— air, thorough ventilation, light, 
and cold. As time will not permit us to enter upon 
theories, and as facts alone can be considered a safe 
basis on which the study of the character and nature 
of yellow-fever can be prosecuted, we mention, as its 
first and most prominent law of existence, a continued 
temperature of So"" and over. Exotic in its origin, in- 
digenous only to the tropics, yellow-fever cannot exist 
in our latitude except during the summer months, and 
with the advent of every frost becomes exterminate. 

With Dr. Rush the last advocate of the domestic 
origin of yellow-fever has passed away; and not only 
in New York, but scarcely in any of the gulf ports can 
a man of eminence be found who is not convinced that 



yellow-fever cannot originate de novo in any ports of 
the United >Slatea, but is always the result nf impurt'ition 
from abroad. During the war the mo.'t ii;.«alubriou8 
ports remained exempt from its visitation, and this less 
on account of an eflicienl quarantine, or inUjrmd sanitary 
regulations, but becau'^e commerce and intercourse 
with infected districts was partially or entirely cut off. 
II. If not indigenous, yellow-fever is necessarily a 
portable disease, and its portation must either be 

a, /'// jtersons laboring under the disease, and repro- 
ducing the morbific germ ; or, 

b. by things, f /miles, ship-s, merchandise, p<;rsonal 
effects, transmitting the germ in its maturity. 

a. liy persons. — The difficulty ofseparating effect from 
cause, and our inclination to draw our indications from 
the visible, perceptible, and tangible, have necessari- 
ly led tiie inquiring mind to look to the yellow-fever 
patient as the meansof portation and communication, 
and thus to overlook the most important facts connect- 
ed witii the transmission and development of the dis- 
ea.se. A clear interpretation of the experience of a 
century, and much negative evidence prove, however, 
beyond a doubt, that persons and their eliminations 
have 110 agency in tiie matter ; for not a single case can 
be traced beyond the source of infection, though thou- 
sands have fled during every epidemic from the stricken 
district, or tlic exposure to fomites, to be nursed and 
cared for where prior to their arrival no case of the 
discTse existed. 

From the opening of the Quarantine Ho.spitals in 
1798 to their destruction in 1858, over 1,200 ca.ses of 
yellow-fever were treated, and not a single instance is 
on record in which the disease was communicated from 
the sick and their eliminations, to patients admitted 
with other diseases ; while the introduction of cholera 
was almost invariably followed by the development of 
similar cases among the other patients. Over 200 
patients have since been treated in the Floating Hos- 
pital, and yet not one of the employes ever took the 
disease. Assuming, then, as an incontrovertible truth, 
that persons cannot be the carriers of yellow-tever viru.«, 
it necessarily devolves upon inanimate matter — vessels 
and fomites — as the only remaining media of transporta- 
tion from its original or acquired liabitat. I may cite as 
evidence in proof, the history of every yellow-fever 
epidemic, both on this continent and in Europe, in 
which the disease could be traced to these things alone, 
although local causes may have contributed to its incep- 
tion and development. 

b. By thinys. — That vessels may become infected, 
and the floating habitat of a local epidemic,' is corro- 
borated by the experience of every year, and the only 
questions before us are : Its source, or the condition 
of the port of clearance requisite for, and the condition 
of vessel and fomites favoring, the inception and infection 
by yellow-fever virus. 

Ports. — Yellow-fever may prevail as an epidemic, 
appalling and intense, or the occurrence of a few spora- 
dic c;iscs may simply indicate the presence of the virus ; 
although the former almost insure infection, the latter 
by no means excludes the possibility. The Alabama 
was infected by yellow-fever at Key West.where its pre- 
sence was not even known to the commander. The port 
may be land-locked, surrounded by swamps and decay- 
ing vegetable matter, as at Havana ; or an open road- 
stead, as Campeche, Tampico, and the probabilities of 
infection may be correspondingly less. Again, the 
vessel may be loaded by lighters, or at the wharf, the 
former not excluding, the latter certainly fovoring, the 
probabilities of infection. 

Vessels. — Old vessels are invariably more liable to 
infection than new ones, to whatever we may attribute 



THE MEDICAL RECORD. 



this predilection ; and that a local cause exists we may 
infer from the fact that we have vessels of bad repute, 
once the habitat of infection, and under ?iniilar circum- 
stances more than likely to be again, although others 
may escape. The James H. GHddev, Julin I/iilleck, and 
Susquch((H7ia, are instances ; in each yellow-fever had 
prevailed repeatedly. Repeated observations also show 
that human eflluvium favors the infection of vessels with 
tlie specific virus of this disease, as it does the occu- 
pants of crowded passenger ships and prisons with t}'- 
phoid. Yellow-fever occurs much more frequently on 
board of men-of-wnr than in any other class of vessels, 
notwithstanding the severe and constant attention to 
cleanhness and ventilation which the sanitary discipline 
imposes. The names of the Buzzard, Enterprise, 8us- 
(jiteluutnii, Ahhnna, and Tahoma stand pre-eminent 
in om- quai'antine records of yellow-fever. B}'' a pas- 
senger ship the disease was first introduced into the 
West Indies. Tlie ship Dehorah, aBritisli transport from 
St. Thomas, carried the disease in 179S to New York ; 
and the only infected vessels which arrived here during 
the summer of 1862 were Coolie vessels, which had dis- 
charged their living freight in Havana, while not one 
of the Havana packets or ordinnry traders appears to 
have suffered by the prevailing infection of the Port. 

Fomites. — Tlie portation of yellow-fever virus by 
fomites, by railroads and other conveyances than infect- 
ed shipping, cannot be the subject of quarantine regula- 
tions, and is of at least questionable occurrence. During 
the terrible epidemic in Norfolk, thousands came by 
rail to every city in the union, and I am not convinced 
of the occurrence of any case from persons or things 
brought thence. 

III. Mode of Infection. — Yellow-fever may extend 
from the infected vessel — 

1. B]! contifiuitij, 

2. Bij winds, 

3. Bij fomites. 

1. By contiguity. — To the law of contiguity we 
may attribute the prevalence of every yellow-fever 
epidemic in New York, commencing invariably in slip?, 
docks, and streets nearest to tlie focus of infection, 
until the approach of infected vessels was prohibited by 
laws, and in its efficient administration the introduction 
and prevalence of the disease prevented. What may 
still occur in the absence of such preventive measures 
we may infer from the history of St. Nazaire, in France, 
in 1861, when the Anne Marie arrived from Havana, 
having lost two of her crew by yellow-fever. On board 
of three vessels moored close to her the crew sick- 
ened in the order of their proximity not only, but 
while the vessel moored nearest to her lost four out of 
five, the third lost only one in seven other crew. 

2. By winds. — Whatever may be tlie nature of yel- 
low-fever virus, its specific gravity is obviously greater 
than air, — as this alone can fix it to the vessel, — and vir- 
ulent in the degree of its density. The lower the stra- 
tum the more poisonous its influence. That by dis- 
charging and ventilating, the virus is dislodged and set 
free, we see in its effect upon the lightermen receiving 
cargo or ballast, and persons bathing in the immediate 
vicinity of discharging vessels. The extension of this 
virus so liberated, and by its specific gravity floating on 
the surface of the water, certainly cannot be limited, 
except by attenuation ; and if theformntive elements are 
found upon the water, or, drifted by wind and wave 
on shore, it finds the matter or formative element on 
shore, it will, under circumstances resembling its tropical 
habitat, necessarily generate and develop. The epi- 
demic on Staten Island in 1848, on Long Island and 
Staten Island in 1856 and 185S, each occurring after 
continued winds from the fleet of infected vessels, may 



be solely attributed to this mode of infection ; while 
the epidemics on Governor's Island, occurring in 1856, 
1858, and 1870 in the same locality, the point nearest 
the Atlantic dock, where cargoes from vessels at qua- 
rantine were constantly received, was unquestion- 
ably due to the liberation of yellow-fever virus from 
these cargoes drifting on the surface, until it found on 
the shores of the island, or the df'biis floating near its 
shores, the requisite formative elements. This drifting, 
as snow in winter, may also account why a fence, a row 
of dwellings, an artificial barrier will arrest the progress 
of the disease ; and why tlie north side of llotten Row 
suffered while the south side remained exempt; on 
Staten Island the houses fronting the bay were infected, 
while others adjoining,fronting inland, remained exempt. 

By fomites. — These may be either materials Jloating 
NEAR, or the cnrgo, dunnage, and personal effects from 
the infected vessel. 

We have unquestionably in the floating material the 
most prolific source of infection. This may or may 
not be from the infected vessel, but debris, decompos- 
ing porous substances constituting the formative cle- 
ment for the floating virus, imder circumstances most 
closely resembling its tropical habitat. 

The straw taken from the Bay by the first victims on 
Fort Hamilton, the mattress at Gowanus, were such; 
though neither could be traced directly to an infected 
vessel. 

Cargoes. — To prove the infection by cargoes is ex- 
tremely difficult, because isolated cases are apt to be 
misunderstood, or hushed up under the apprehension ot 
public alarm, or reproach for ofBcial negligence. In 
1822 the epidemic was attributed to a quantity of su- 
gar stored at the foot of Rector street. Custom-house 
ofticers were reported sick of yellow-fever while em- 
ployed at the Atlantic Dock, Brooklyn, in 1856; and 
Sleight, a custom-house officer not connected with 
quarantine, is said to have died of yeflow-fever in 
1848. 

The law makes distinction in cargo and the charac- 
ter of "fomites" liable to carry disease, which is per- 
haps not wliolly based upon "facts. Rags, unwashed 
and from an infected port, may certainly be potent car- 
riers; and as the history of the J. II. Olidden teaches, 
a prolific source of infection, as also hides and animal 
remains. On the Chr. Martell seven out of twelve 
employes sickened, who had carried the partially de- 
cayed sheep-skins on deck. But few cases are known 
where general cargoes and the products of the tropics 
proved injurious, unless in a state of decomposition. 

Dunnage and Personal Effects. — That dunnage from 
the hold of an infected vessel may carry the virus we 
have the evidence in the Susquehanna. A Watch- 
man (?) slept in the folds of a sail removed from the 
hold of the ship the previous day ; he sickened in five 
days, and died of yellow-fever. 

That the virus may be carried a great distance by 
personal effects we have in evidence the well-known 
instance of the chest of clotliing carried from Martinique 
to New Haven, in 1794; the clothing of a dead sailor, 
washed in Lombardy St., in 1822, and infecting all pre- 
sent; the disease of the Sinclair family in Quarantine, 
in 1848, attributed to the clothing of stevedores sick 
with yellow-fever; and, more recently, the case of the 
mate of the Cravford, who went from a vessel, which 
subsequently proved infected, on board of another, out- 
ward-bound, the captain of which sickened three days 
after he slept in the bunk above the one containing the 
mate's clothing — in every instance the effects came 
from localities positively infected, without being opened 
and ventilated, and carried to localities favoring in- 
fection. 



THE MEDICAL KECORD. 



After careful considiTation of the natiiiv of yellow- 
fever, conclusively proving its exotic origin, nnd that 
it c.innot occur in our latitude unless carried by vessels 
and fviniiU'S, the condilions of infection of vessels 
abroad and the means of conveyance to our shores — the 
quarantine measures to prohibit the introduction and 
prevalence of the disease is the question of tliC great- 
est iinporlancc. 

The Quarantine of Yellow- Fever. — By law all vessels 
from any i)oint south of Georgia, the coast of Africa, 
and the ^lediterra'.lean are boarded from the hospital- 
ship, anchored about three miles below tin; Narrows. 
Upon examination of the bills of health, the sanitary 
record, and the present condition of pasoengers and 
crew, immediate prutiiue is (/ranted, or the vessels are 
detained to remain under observation, or perform 
quarantine. Inmiediato pratique is only granted if no 
])retoxt wliatever exists to retain the vessels. I use 
the word pretext purposely ; fir as long as the Health 
Officer is the beneficiary of his own acts, and every 
vessel quarantined is a source of revenue, as during 
the past few years, it is scarcely to be presumed that 
he will lean towards the master of the vessel, anxious 
to end his cruise and join his home, who finds even a 
few days' quarantine very irksome. 

The quarantine of observation applies to all vessels 
coming from any port suspected of being infected, or at 
any time the seat of an epidemic, and implies a qua- 
rantine of from two to five days, opening of hatches, 
ventilation, and fumigation — provided the placing of 
half a dozen plates of black oxide of manganese, chlo- 
ride of sodium, and dilute sulphuric acid merits the 
name of fumigation. 

If the sanitary condition of the port of clearance is 
more questionable, or the cargoes of such a character 
that it belongs to the first class, as designated by law, 
the quarantine is extended from ten to fifteen days; 
and should the suspicion amount to positive evidence 
that sporadic cases occurred in the port of clearance, or 
any port where the vessel stopped on her homeward 
passage, the vessel is detained either with her own 
crew or with a crew of ship-keepers, for a period of 
from twenty to thirty days ; and only if all remain 
well, and later reports from the port of clearance show 
that yellow-fever is not epidemic, the vessel receives 
stream permit, or direction to discharge on an isolated 
dork or irarehouse. 

It will be remembered that by the laws of 1805 vessels 
suspected of being infected were prohibited from com- 
ing nearer the wharf of the city than 300 yards ; and 
the '■ stream perfliit " is unquestionably yet in obedi- 
ence to tliis ancient law, and certainly one of the best 
provisions whenever a question as to the sanitary 
condition of the vessel exists. " Isolated stores and 
warehouses " is of course a relative term ; the stores 
especially mentioned are, however, the west side of 
the Atlantic Stores, Brooklyn, which, surrounded by 
water and built of stone, and at least ha'f a mile from 
any dwelling, offers lacilities of isolation and compara- 
tive security which no other presents. Should Robin's 
Reef be built up by stone, as granted by tlie Legisla- 
la!ure, it would of course supersede the Atlantic bock 
for all quarantine restrictions. 

A vessel arriving from a port declared to be infected, 
by foul bills of health or private information, is suspect- 
ed of being infected, though all are well and have been 
during the passage. After a few days' quarantine she is 
discharged by licensed stevedores and lighters, and no 
pratique granted until sufficient time has elapsed to 
prove, by the continued good health of the employes, 
that she is not an infected vessel. 
By the discharge of vessels we have not only thor- 



ough ventilation, efficient means of disinfection of ves- 
sels and cargo, but, in the continued good healtii of a 
number of unacclimated employes, exposed lo tiie virus 
umler the most unfavoraljle circumstances, a number 
of negative evidences amounting lo positive assurance 
that the vessel is not an infected ves.sel. 

From the same port vessels may arrive, on board of 
which cases of yellow-fever may have occurred while 
in port or on tlie iiassa;^e, but no cases after the fifth 
day of her di-parture; ^he may be an infected vessel, 
but no positive evidence is adduced, since all her cases 
may be traced to the port of clearance ; she is treated 
in the same way, receiving jiratique only after every 
evidence manifests her sanitary condition. 

Another vessel arrives with new cases of yellow-fever 
occurring si.x and more days after leaving port, or even 
after her arrival in New York Bay ; she is quarantined 
in the Lower Bay for thirty days after the occurrence 
of the last case, then discharged by lighters, her cargo 
only receiving conditional pratique, .and the vessel only 
alter every evidence that she is no longer an infected 
vessel. When, however, this evidence confirms that she 
is and remains an infected vessel, she is quarantined till 
frost, her only solvation. 

A difficulty arises in the treatment of vessels in bal- 
last ; in this ca«e ship-keepers are placed on board, the 
vessel is cleansed, and the ballast moved by persons un- 
acclimated to the disease, and the vessel treated as 
others. 

Thanks to a manifest Providence, by this course not 
a single case of yellow-fever occurred in New York or 
harbor while Dr. Gunn was Health Officer, although 
over 500 vessels arrived from infected ports, and 10 
vessels were declared positively infected, being refused 
pratique until after the middle of October. 

It willihus be seen that the percentage of infected 
vessels in vessels coming from infected ports is only a 
little over two per cent., or rather that the ordinary meth- 
od of disinfection by ventilation and fumigation suffices 
to eradicate the virus of the disease, or, by extreme at- 
tenuation, renders it harmless. 

It may appear strange that no provision should exist 
in our port for these positively infected vessels; but as 
frost alone exterminates the virus, and any other meth- 
od would necessarily entail loss of life, quarantine till 
frost is after all the only safe method, and more readily 
submitted to b}' masters and owners than exactions 
which they deem frivolous and unnecessary. 

Disinfection of vessels. — Frost alone can positively 
eradicate the disease, and to apply this so as to bring 
the temperature on board the vessels below the freez- 
ing point during the summer months is difficult, but 
by no means impossible, and only a few abortive 
trials have been made during the administration of Dr. 
Gunn. 

Ventilation of vessel and cargo may, and, as our experi- 
ence proves, will, fti a measure, disinfect vessels, for we 
know that by discharging of cargo or ballast the virus 
I is liberated, and vessels showing the most positive 
proofs of being infected on arrival, in the course of 
time give sufficient negative evidence to doubt longer 
that she is an infected vessel ; but neither white-wash- 
ing three times, as under former laws, nor fumigation, 
nor ventilation, nor even scuttling, will positively dis- 
infect an infected vessel. 

Fumigation. — The very method of fumigation as now 
employed in quarantine shows the utter contempt for 
this method of disinfection, and I doubt very much if a 
medical man can be found who believes that chlorine, 
to the amount used on board of these vessels, can have 
any effect whatsoever in the disintegration of the virus; 
and neither bromine nor carbolic acid, nor any other of 



THE MEDICAL KECORD. 



our disinfectants, can really prove more than mere aux- 
iliaries in llie disinfection of vessels. 

Tlie Upi^er and Loicer Bay as Quarantine Slations. — 
The detention of vessels at the Lower Quarantine, both 
while under observation and quarantined as suspected 
or infected vessels, commends itself so positively to our 
view of quarantine that it needs no argument in its fa- 
vor, and the discharge of suspected vessels at the Up- 
per Quarantine is excusable only by want of faeihties 
at the Lower Bay, and at no time should more than 
two or three vessels be discliarged at once, and at a suf- 
ficient distance from either shore, to insure immunity. 
Should stevedores or other employf-s sicken during the 
process, the vessel is to be returned to the Lower Bay 
and treated as an infected vessel. 

Ship-heepcrs. — The employment of ship-keepers to 
act as tests for the sanitary condition of the vessel may 
appear questionable; but as they fully understand their 
position, and are correspondingly paid, they voluntarilj^ 
assume the responsibility. 

Sievedorinc/. — The stevedores are the most important 
instruments in the hand of the Health Officer — his baro- 
meters, bjr which he judges the sanitary condition of 
the vessels ; yet as only suspected vessels are to be 
discharged, or in equity can be discharged, the steve- 
dores enjoy a certain security, although, of course, they 
are exposed to constant danger. Under the regime of 
Dr. Gunn they were mostly residents of Staten Island. 
Roll was called every morning, and any absentee im- 
mediatel}'' visited, and, if sick, taken to the hospital. 
The vessel where he contracted the disease being, of 
course, the one Avhere he labored five days — the univer- 
sally accepted time of incubation in yellow-fever — pre- 
vious to his illness, and such vessel then considered an in- 
fected vessel. At present a barge anchored in the Ba}^ 
answers for their residence, and, of course, places them 
still more under the vigilant eye of the Health Officer. 

Lightering. — Under the present law, vessels in quar- 
antine are lightered by persons and vessels licensed for 
that purpose by the Health Officer, and though their 
compensation is fixed by the Quarantine Commission- 
ers, the exactions under this monopoly are such that 
the lightering of cargo in quarantine is considered one 
of the most oppressive burdens of commerce. And 
when we consider that the vessels so licensed are daily 
at the wharves of the city, and used at the option of 
the owner for every other purpose, we must certainly 
question the ecfuity of law which grants such monopo- 
lies. It ia true that men on board are subject to infec- 
tion by yellow-fever, but this can only happen if the 
sanitary condition of a vessel has been improperly 
judged ; and if it should happen, no one behoves at the 
present day that a man sick with the yellow-fever could 
communicate the disease to others in his residence. 
The onl}^ thing necessary, then, and justifiable by reason 
or experience, is that the men employed in quarantine 
shall give bonds to the effect that any sickness occur- 
ring among their employes shall immediately be re- 
ported to the Health Officer. 

IN VARIOLA. 

An efficient quarantine is established by'prevcnting 
the intercourse of the community with variola, and 
the personal eliminations of the disease. Yariola did 
not' exist on this continent before the advent of the 
Caucasian race, and cannot originate de novo among 
the nations which have supplanted the ' Aborigines. 
It may, therefore, become absolutely extinct if we 
succeed in cutting off all intercourse with the per- 
sons diseased and their eliminations. The persons are 
either the patients already manifesting the presence 
of the disease in the particular eruption, or persons ex- 



posed to the virus, in which the disease has not yet 
made its appearance. The eliminations of the dis- 
ease are its products — the scab in its progress to ma- 
turity, and the more ethereal eliminations impregnating 
j the clothing and other personal effects of the diseased 
! within a certain distance. What this distance may 
be, and the medium of its propagation, I am as unable 
to determine as I am to explain how far the odor of 
the patient may be cnrried, and by what means. 

We find, perhaps, in this a vague but approximate 
analogy. Certain it is that in no instance has the dis- 
ease been known to have been communicated from 
the Small-pox Hospital at Quarantine to the surround- 
ing village, a distance of some 300 feet. An interest- 
ing and rather amusing incident was related to me by 
the captain of a Coohe vessel, on which small-pox ap- 
peared soon after leaving port. He had a coop erected 
in the mizzen-top, where he placed his two patients ; 
not only did no new cases occur among the passengers, 
but the convalescents descended hale and hearty after 
spending three weeks there. Another captain quaran- 
tined a case of small-pox occurring among his crew, by 
placing him in a boat hung by a davit (rom the stern 
of his vessel ; the man recovered, and no new cases 
occurred. 

Small-pox patients are now carried to the hospitals 
on Ward's and Blackwell's Islands, and the only ques- 
tion is the propriety of the mode of transportation in 
boats used for other purposes? In the determina- 
tion of the quarantine of well passengers, exposed to 
the virus of small-pox, the extent and source of the 
disease, as well as the mode of isolation of the sick, 
must necessarily guide the Health-officer in granting 
pratique. If occurring as an isolated case, only trace- 
able to the port of clearance, vaccination of the pas- 
sengers and immediate pratique is all that is desir- 
able. When, however, a number of cases have occurred, 
the port of clearance not being the source of infection, 
but the sick on board of the vessel itself, thorough 
vaccination, and revaccination of all that have not 
taken the vaccination after four days' quarantine, are 
indispensable ; and as vaccination only rec[uires three 
days to manifest in its success entire and absolute 
immunity from the disease, pratique may then be 
granted, wiih the assurance that no new cases of 
variola will develop themselves. If not thoroughly 
vaccinated, new cases may occur, from seven to twenty- 
one days after the first case, or thirteen days after 
exposure and the maturity of the first case. For this 
reason I would commend the mode instituted by our 
lamented Dr. Gunn, who ordered the vaccination to 
be done with fresh lymph, by Dr. J. P. Loines, of the 
Eastern Dispensary, — almost invariably showing the 
desired result on the fourth day. The superiority of 
this plan over that of vaccinating from a scab, carried, 
perhaps for weeks, in the pocket of a police officer, 
appointed for the nurpose of vaccinating, can scarcely 
be a matter of doubt in the profession. I would sug- 
gest, as a sanitary measure, that all vaccination be done 
by the vnccinating dispensary which may offer the 
greatest facility of obtaining, at all times, sufficient 
fresh lymph. In this way, not onl}- would it be done 
thoroughly, but the Health Officer would be relieved 
of the suspicion of giving orders merely for his own 
pecuniary benefit. 

The disinfection of clothing, bedding, or personal 
effects, impregnated by the ehminations of small-pox 
patients, may be effected by a continued high tempera- 
ture, interment, or fumigation, or by over twenty-four 
hours' exposure and ventilation on a warm summer's 
day. Thirty minutes' exposure of the scab of the 
small-pox patient, — the most concentrated form of 



THE MEDICAL RECORD. 



porsoiml eliniiiiatioiis — to a toinpernturo of 130" and 
upwards, will di-slroy iLs virus as eflVctually iis three 
days' liiirial in dry clay — a process cniciont f-nouf^li, not 
only to render the virus perfectly inert, but also to 
exterminate the pediouii so ofleii infecting the clothing 
of small-jiox pa'ients. Simple washing and boiling 
•will disinfect — but this measure may l)e carrii'd ad 
ahsiinluin, if not oidy the effects of tlie patient, and 
tlie materials within the reach of the elinnnalions of 
the sick, but all the elTects of the passengers of a first- 
class steamer are also required to be so treated. The 
vessel itself recpiires no further quarantine than is 
required to wash and clean the rooms occupied by the 
sick, and by fumigation, entirely destroying the germ 
of future infection. A scab from a patient exposed to 
the fumes of nitrous a'id will oidy becDme inert after 
continued exposure; while chlorine will only jiroducc 
its etVect in its concentrated form. Fumigation in 
small-pox is, therefore, to say the least, a questionable 
expedient, and certainly much less reliable than high 
temperature. 

Having thus briefly spoken of the quarantine of 
small-pox, and recommended the immediate removal 
of the patient, vaccination of the well passengers, 
washing or burying their personal effects, and the 
cleansing of the vessel, let us proceed to the quarantine 
of typhus. 



The records of the quarantine hospital show that 
cases of t^'phus were admitted during almost every 
year, from its opening, in 1798, to the present day, 
almost invariably occurring after long passages on 
board of crowded vessels, with insufficient and 
unwholesome food. But it was not until after the 
Famine in Ireland, in 1847, that the disease really 
became epidemic. From that year until 1853 over 
twentv thousand cases were admitted and treated in 
the Marine Hospital, crowding the buildings to over- 
flowing, and necessitating the temporary occupation of 
the public stores for hospital purposes. These were 
four stories high, large and massively built, with ceil- 
ings not more than nine feet high. The mortality in 
these was, however, so fearful that they had to be 
abandoned, and temporary shanties erected, thereby 
diminishing the percentage of deaths to nearly one- 
half Since 1853 the number of cases has been steadily 
decreasing, until in the last few years comparatively 
few well-authenticated cases have occurred eitlier on 
ship-board or in the Emigrant Hospital. "With increased 
facilities of intercourse and commerce, of railroads and 
steamboats, famine has become well-nigh an impossi- 
bility, and typhus, the legitimate offspring of inade- 
quate nourishment and bad ventilation, has ceased its 
ravages in Ireland, its principal habitat. With the 
advent of ocean steamers and quick passages, it is 
scarcely possible that we shall evearhave any consider- 
able number of typhus patients to provide lor, or that 
there will be occasion for quarantine regulations to 
prevent its introduction. Typhus can originate as an 
epidemic only from ^rand national disasters, and, as 
already mentioned, it follows in the wake of famine 
and destitution, and is communicable, contagious, and 
infectious only by personal eliminations of the sick 
poisoning the immediate atmosphere, and rendering all 
within its precinct amenable to infection. The more 
concentrated the poison, by reason of the great number 
of the sick, and the less the number of cubic feet of 
air allowed to each sick individual, the more intense 
the poison, and the greater the danger — hence the 
terrible mortality in the public stores^ already men- 
tioned, where not merely fifty per cent, of its inmates, 



but also of the nurses and attendants who entered 
them, were among the victims. To the same cause 
may also be atiibuted the virulence of the disease on 
board of emigrant vcs'sels crowded with pa.ssengers, 
imperfectly fed, and witli less than the re(iui.site amount 
of air to sustain a healthy condition. l3r. Doanc, the 
lamented Health Officer, died after a single visit to 
the steerage of one of these ve.s.sels. As heated air 
ascends, so will the air impregnated with the virus of 
typhus ascend — in proof of which I may give my 
experience in one of tlie typhus wards, in which almost 
every patient in certain beds of the ward died, while 
others recovered. Upon examination it was found 
that a shaft communicating with the ward below 
opened directly under these beds. For the same rea- 
son we find that on board of emigrant vessels the disease 
is much more prevalent in the neighborhood of air- 
passages, communicating with the lower deck containing 
ca«es of this disea.se, than elsewhere. And while the 
morbific cause of the disease is so potent in the wards, 
it is a singular fact (hat a few feet beyond it, and 
by the interposition of a comparative narrow stratum 
of pure air, all danger ceases. There is not a single 
instance on record in which the disease was communi- 
cated to a distance greater than one hundred feet from 
the typhus ward, where every attendant sickened and 
many died. 

The quarantine of typhus, therefore, is simply isolation 
of the infected ; and the present provision at Ward's 
Island is probably as good as can be provided, as no 
possible danger could accrue to the city in their tran.s- 
portation, or to the other sick of the hospital, if any 
number of typhus patients should be provided for in 
isolated buildings on the island. Not oidy those sick 
of typhus, but all who have been exposed to, and there- 
fore subjl'ct to the disease within the ordinarily accepted 
period of incubation, should immediately be removed; 
and I know of no place better adapted for the reception 
of sucli passengers than the extensive fields of Ward's 
Island, where, during the winter season, they can be 
placed in well ventilated houses; but in summer, if 
possible, they should live in tents. An instance of a 
quarantine of this kind we had a few years since in 
Perth Aniboy, where the passengers of a badly infected 
vessel were disembarked, quarantined in open tents, 
and not a single case occurred after their disembaika- 
tion. Indeed, I hold the practice of retaining the pas- 
sengers on board of vessels on which typhus had pre- 
vailed as most reprehensible ; for although the sick 
may be removed, and every precaution taken to pre- 
vent the further progress of the disease, it cannot thus 
be arrested. In the instance of the Ctpiosure we have 
the most painful illustration of this. Not only did fur- 
ther cases occur after debarkation at Quarantine, but 
I valuable lives were lost, and the entire depot at Castle 
: Garden was endangered by this nefarious practice. 
The quarantine of vessels after the debarkation of the 
1 sick and well is only requisite for the time necessary 
I to thoroughly cleanse and fumigate them ; and here the 
\ fumigation by chlorine gas, generated from a mixture of 
j the black oxide of manganese, salt, sulphuric acid, and 
water, is certainly the most efficacious. Merchandise 
. from vessels with typhus on board can never be the 
subject of quarantine ; for there is no instance on record 
in wliich it was, or could possibly have been, the mor- 
bific agent of the disease. 

CHOLERA. 

The literature of cholera is so voluminous, and the 
history of its Indian origin and prevalence, its migra- 
tion over the Continent of Europe before it reached 
America in 1832, is so familiar to all that I cannot pre- 



THE MEDICAL RECORD. 



sume to refer to it except in its relation to the subject 
before us — the quarantine of cholera. 

The verdict of the ablest wiiter is, " that all quarantine 
and sanitary cordons are useless." I admit at once the 
truth and equity of the verdict, unless all intercourse 
■with the locality whore the disease prevails as an epi- 
demic, even in a limited form, is absolutely and entirely 
out off; for the researches of Pettenkofer, corroborated 
by our own experience, prove beyond a question, that 
though persons from an infected locality are invariably 
the pioneers of the disease, vi'hcrever it occurs, they 
may be apparently in p;ood health when they leave the 
source of infection, and unconsciously to themselves, 
or inappreciably to others, be the carriers of the 
disease. But while admitting this as truth in Europe, 
and on this continent if the disease has once taken a 
foothold, 1 make the assertion with as much assurance, 
that with a sanitary cordon of 2,000 miles in width, and 
a lapse necessary for its transit of ten daj'S or even 
move, an efficient quarantine ma}' prohibit and absolutely 
prevent the introduction of the disease into America. 

Before 1832 the records of quarantine exhibit, almost 
annually, deaths from " cholera morbus ; " but not until 
the lOtii of July of the year named have we any rec- 
ords of Asiatic cholera at the quarantine hospital. 
The disease had then already become epidemic in 
Quebec and Montreal. Whether it had been conveyed 
to this port by the Henry IV. from Havre, or whether 
it had been brought hither by the ship Carrick from 
Europe, arriving on the 1st of June, only a few weeks 
prior to the Henry IV., I will not undertake absolutely 
to decide. It is rather ominous that the first two cases 
Avere admitted from New York, and not from ship-board. 

A brig bound from New York to New Orleans was 
wrecked on Folly Island, and the passengers and crew, 
among whom cholera had prevailed previous to the 
disaster, were taken ashoi-e. The disease extended to 
the feAV negroes and wreckers living there ; physicians 
and nurses were sent from Charleston to attend the sick. 

In January, 1833, a man-of-war arrived at Havana 
with cholera on board. In February it became epi- 
demic in the town, carrying off" over 10,000 persons, or 
10 per cent, of all its inhabitants. 

In 18-iS cholera prevailed in Bremen. Unal^le to 
procure the desired accommodation, a number of emi- 
grants went to Havre, and thence took passage on the 
New York sailing on the 9th of November. On 
the loth cholera first appeared among the passengers 
from Bremen. On her arrival here in New York, on 
December 6th, seven had died and eleven were landed 
sick. The remainder were landed at the public stores. 
Many were subsequently taken sick, and the disease 
extended to the hospitals and the surrounding build- 
ings — the first case occurring on the 6th of December 
in the building nearest to the ward where the female 
cholera patients from the Neio York had been placed ; 
and on the 8th of December another, in the ward con- 
tiguous to the cholera hospital for males; on the 10th 
of December several cases occurred in the building 
where patients from the same ship with other diseases 
had been placed. In all, over 100 were attacked. 

In the spring of 1819 a number of vessels arrived 
with cholera on board, the disease again extending to 
other patients, over 100 dying. But it was not until 
May that it made its appearance in New York. 

In Boston the Argyle arrived from Scotland, with 
cholera on board, on the 4th of June. 600 deaths 
occurred from the 11th of June to the 13th October. In 
New Orleans the first case of cholera came from the 
ship Swinton, arriving on the 2d of December from 
Havre ; and from the 11th of December until the 7th of 
February ov^er 1,200 died. 



The fatal consequences that have almost invariably 
followed the new introduction of cholera during the sub- 
sequent years, have not been so appalling as the above 
mentioned. But the books of the Marine Hospital 
prove that, in almost every instance when cholera was 
brought here from ship-board, the disease spread among 
the sick inmates nearest to the wards containing the 
patients, and more than once decimated the hospital 
in its fearful progress. 

In 1858 the quarantine hospitals on Staten Island 
were destroyed by a mob, and the port of New York 
remained exempt from a visitation of cholera until 
1866, when the Atalanta arrived from Havre, reporting 
60 cases and 15 deaths from cholera during the passage, 
and having 21 sick with cholera on board. These, and 
23 other cases which occurred while the vessel and 
passengers were at quarantine, were sent to the Float- 
ing Hospital. Thirty days subsequent to her arrival, 
and ten days after the occurrence of the last case, the 
vessel received pratique, and no further cases were 
reported either among the passengers discharged or the 
employes of the hospital. About the same time cases 
of cholera occurred on vessels arriving from the same 
ports; but the disease again disappeared before they 
reached New York. It is, however, remarkable that 
the disease, on these vessels at least, could be traced 
to the same hotel in Havre ; all parties corroborating the 
statement that several persons died of cholera while 
the passengers who became the first victims on the 
different vessels boarded there. 

If, then, as cleaily proved by the facts before us, cho- 
lera never appeared here except when brought from 
abroad ; and persons were invariably the carriers of the 
disease, both to the vessel and from the vessel to the 
shore, the quarantine of cholera is a quarantine of per- 
sona, and the virus, reproducing the disease, is the 
personal elimination of the cholera patient, but differ- 
ing from the virus of small-pox and typhus — both 
eruptive diseases — in not being the eliminations of the 
skin but of the alimentary canal. 

The "Floating Hospital" used on the emergency of 
the arrival of the Atalanta' s passengers was, for the 
purpose, certainly preferable to the hospital on Staten 
Island ; for not only was their isolation more perfect, 
and the danger of communication to convalescents or 
sick of other diseases, especially typhoid, avoided, but 
the dejections of the cholera patients, incontrovcrtibly 
the principal receptacle of the morbific agent, and the 
generative principle of the disease, were cast into the 
sea, and with them all danger of infection and commu- 
nication was avoided. The buildings on West Bank, 
lately erected, may offer greater facilities and comforts, 
but scarcely as much security. The well passengers of 
cholera-infected vessels may be divided into two clas- 
ses : the first, where the disease already exists, but the 
patient suffers merely from a colliquative diarrhea, 
scarcely more than a matter of incouvenience to him, 
but equally morbific in its agency as the dejections of 
a cholera patient in a state of collapse ; the .second 
class, merely the subject of the incubation of the dis- 
ease, but in whom no development has as yet taken 
place, comprising, of course, all the pa=sengers exposed 
to the morbific agency of the disease. For this class, the 
buildings on West Bank are most admirably adapted. 
The time of quarantine may be fixed at 10 days after 
the occurrence of the last ca^e, being three days longer 
than the accepted period of incubation. Though this 
may seem long, we must not forget that a single case 
may be the cause of an epidemic, as clearly proved by 
Pettenkofer, in the history of cholera at Altrau, in 
1865, when the disease Avas introduged by a lady direct 
and only five days from Odessa; in Thoyden Bois, in 



JO 



THE MEDICAL RECORD. 



Enpland, bv a pcntleman from London, and in our hos- 
pitals, by the arrival of a single cholera patient from 
Aspinwall, 

The cpiarantinc of merchandise may be safely re- 
duced to the quarantine of merchandise soiled by the 
<h'je>tion» of cholera patients, and to personal effect*. 
Dr. Simpson relates a cai;e of the transmission of the 
disease by a chest of duthinfj fri)m a cholera patient, 
aideil perliaps b}' the use of unwhulesomo food con- 
tained in till) same chest. That the disease in the 
Marine Hospital almost invariably attacked others in 
t!ie same buildinp or in the adjacent ones, may be ex- 
plained by the fact that tlie soiled linen of cholera pa- 
tients was placed in a building attached to the water- 
closet, and allowed to remain there for days, these 
being only a few feet distant from the shanties used for 
the reception and treatment of the cholera patients. 

The disinfection of the clotliin2; and rags, the only 
merchandise which properly can be so|led by the de- 
jections, can be eOTected by ventilation, fumigation, and 
submerging in a sohuion of the sulphate of zinc, or, 
better still, of carbolic acid. How long sucli effects 
may retain the cholera virus is rather a matter of 
opinion than of positive demonstration, and if effects 
infected with tlie cholera virus may be disinfected by 
exposure and ventilation, and if cholera effects dis- 
infect;Hl in this way may c;iminat3 the morbific virus, 
through our own medium, the air. the most pertinent 
questiou is the distance to which such morbific agent 
may be carried. In answer I may cite the theory of 
Mr. Simon, that the cholera germ diminishes in ratio to 
the square of t'.ie distance from the point of emission. 
Certamly no case has come under my observation, 
where the gerui was carried more than 200 feet, and 
the hospital on West Bank oilers, therefore, t!ie desired 
seen ri ty. 

The quarantine of vessels, after the discharge of the 
passengers, and thorough fumigation and washing by a 
solution of carbolic acid, is scarcely necessary beyond 
the time required to do this; and the first instance has 
yet to be adduced where the infection could be traced 
to vessel or cargo. 

In speaking of the quarantine regrulations, I have 
treated the subject as my long experience and famili- 
arity with the practical workings of quarantine de- 
mand; and in presuming tj make suggestions before 
the Academy of Medicine, I invite their delibera- 
tions to questions which can only be decided by men 
of science, and thoroughly familiar with the mode of 
propagation of each disease. The community looks to 
the profession as its legitimate guardians, and the mer- 
chant for relief from exactions and impositions. 



VACCINATION DURING THE FEVER 
STAGE OF VARIOLA. 

By J. H. TYNDALE, M.D., 

HOUSE SUBGEON, GERMAN HOSPITAI., N. Y. 

Previous to the great discovery of Sir Edward Jenner, 
towards the close of the eighteenth century, the rate 
of mortality from small-pox was enormous, and is 
estimated to have reached fifty per cent. Moreover, the 
symptoms and course of the' disease were of a more 
aggravated character. No wonder then that efforts had 
been made from the earliest periods to mitigate the out- 
breaks of the epidemic by preventive measures, as well 
as by the administration of remedies. 

When and where inoculation originated is not known. 
From time immemorial the Chinese have practised a 
method of" sowing'or disseminating '" the disease, which 



consists in introducing the scales of the eruption into 
the nostrils. At a very remote period, in Hindostan, 
a tribe of Brahmins resorted to it as a religious ceremo- 
ny. A small incision was made, and cotton soaked in 
the virus applied to the wound. Oflerings were devot- 
ed to the goddess of spols to invoke her aid ; this divi- 
nity having first hinted at inoculation — " the thought 
being much above the reach of human wisdom and fore- 
j sight." But the merit of introducing the practice into 
England, from Turkey, is due to Lady Mary Woriley 
Montague. Writing from Adrianople, in April, 1717, 
she observed: "Every year thousands undergo this 
operation ; and the French Ambassador says pleasantly 
that they take the small-pox here by way of diversion, 
as they lake the waters in other countries. There is 
no exam|de of any one that has died in it; and you 
may believe I am very well satisfied of the safety of 
the experiment, since 1 intend to try it on my dear lit- 
tle son. I am patriot enough to take pains to bring 
this useful invention into fa.shion in England." (The Let- 
ters and Wurks of Lady Mary Wortley Montague, third 
edition, vol. i., p. .'509. London, 18G1.) 

The debt which our ancestors owed to this lady 
is not diminished by the fact that inoculation had been 
practised for very many years in South Wales, where 
it was known as " buying the small-pox ; " for this cir- 
cumstance only became generally recognized as Lady 
Montague's views engaged attention, and while she 
enjoyed the privilege of being the best-abused person in 
England." 

It has been calculated by the Ragistrar-General of 
England, that the average number of deaths aimually 
occurring from small-pox in London, during the years 
1660-79, were 357 to every 100,000 inhabitants, where- 
as in 1859 they were A'l only lor the same proportion. 
Later statistics have reduced this proportion still further. 

But even the most palpable evidences of the bene- 
fits of vaccination have never sufficed to quell the oppo- 
sition to it. Statistics have been published, laws passed 
and enforced, and still the voice of opposition is as far 
from being stifled as it was nearly one hundred years 
ago. It is even at present so vehement that intelli- 
gent physicians have entered their protest against vac- 
cination as utterly inefTective. The press has also to 
some extent endeavored to establish the futility of the 
enforcement of the measure. To defeat this broad asser- 
tion nothing is needed but a reference to the statistics 
of au}' country, since the introduction of vaccination. 

Some of the objections urged seem at first glance to 
be quite reasonable; but on closer scrutiny it will be 
found that all are based upon false presumption?, and 
consequently woithless. 

It has been argued: 1st. That the prevention was 
wor.se than the disease; the dissemination of the poison 
throughout the body was paramount to an introduction 
of the disease itself, the consequences whereof could not 
be calculated. While it is true that the poison is intend- 
ed to be and is disseminated throughout the sj^stem, it 
must be remembered that the constitutional disturbance; 
caused by the introduction of the virus is of the mildest 
character, and never productive of evil results. On the 
other hand, the benefits derived from it are immunity 
from the disease for a period of from seven to ten years, 
and certain immunity at the time of an epidemic, as 
my experiments, to be spoken of hereafter, will conclu- 
sively prove. 

A second objection is the possibility of engrafting 
upon the constitution such diseases as syphilis, scrofula, 
etc., by means of virus taken from persons afflicted with 
these diseases. There can be no doubt that by the use 
of a foul lancet pyaemia has been caused, and abundant 
evidence exists of the fact of syphihs having been com- 



THE MEDICAL RECORD. 



11 



muiiicated by vaccination. The use of a dirty lancet 
can, of course, and ought to be avoided. As to the in- 
troduction of syphihs and other blood contaminations, 
Dr. Viennois, in an exhaustive paper upon the subject 
(Archives Generales de MCdecine, vol. i., p. G41 ; vol. ii., 
pp. 32, 297 ; Paris, ISGO), has come to the conclusion that 
if" the lympli from a vaccine vesicle alone be introduced, 
the cow-pox alone will be introduced; but if in addi- 
tion the blood of a person afilicted with syphilis be 
also inoculated, then sypliilis will likewise be commu- 
nicated. At the present period, lymph from the vesicle 
is almost universally employed, a fact to which I will 
refer again hereafter. 

Tlie third, and perhaps most plausible objection, is 
the uncertainty of a fixed period of immunity. The 
term of immunity is variously estimated at from seven 
to ten years, after which time the protection is sup- 
posed to have lost its power. Prof. Felix von Niemey- 
er, lately deceased, had instituted inquiry in that di- 
rection, and promised a treatise upon the subject at 
some future day. The work may have appeared lately, 
but has not come under my observation. Niemeyer 
feelsjustified in concluding in advance that vaccination is 
at all times necessary during an epidemic. Now in a city 
like New York, and all large places, small-pox never 
entirely disappears, and an epidemic is only spoken of 
when the cases are multiplied beyond the ordinary 
number. It is at such times that our health authori- 
ties, ever watchful of the welfare of their fellow-citi- 
zens, issue orders for the disinfection of affected neigh- 
borhoods, and urge the people to permit themselves to 
be vaccinated. Perhaps compulsion would be a better 
course. And then it is that the question arises, not only 
whether previous vaccinations will procure immunity, 
but whether the same now performed is to be consid- 
ered a perfect safeguard during the present epidemic. 
There is often doubt in the minds of persons, coming in 
contact with the small-pox, who have subsequently 
been successfully vaccinated, whether they would not 
have escaped the disease without being vaccinated. 
This is in a great measure encouraged by the assertions 
of those who have been, or imagined themselves to have 
been, in contact with it, and providentially escaped in- 
fection either without previous or present vaccination. 
The escape is generally credited to an abundance of 
moral courage. This induced me to ascertain whether, 
after a positively decided contagion has taken place, 
and, the period of incubation being passed, the fever 
sets in, it would then be of any avail to vaccinate. 
And the results more than fulfilled my expectations. 
An epidemic of small-pox, which broke out in the city 
of St. Louis, and continued for three or four months, 
furnished the necessary material. While I was acting 
in the capacity of public vaccinator, a young man pre- 
sented himself for admis.sion into the hospital, suffering 
from all the preliminary symptoms of variola. He stated 
that he had been nursing his brother, then lying sick 
Avith small-pox, for the past twelve days, relying for 
protection against the disease upon vaccination perform- 
ed in his childhood. For the past forty-eight hours he 
had high fever, with intense frontal headache, well- 
marked pain in the back, swollen tonsils, and, in short, 
every premonitory symptom of variola. I vaccinated 
him carefully, and sent him to tlie hospital to await the 
result. 

On the following day (expectant treatment having 
been followed) the fever, headache, and pain in the 
back had abated. An elevation at the point of vacci- 
nation and a slight redness indicated the success of the 
inoculation. The patient fth perfectly comfortable. The 
vesicle gradually dried up and ft^ll off about the eight- 
eenth day. No further symptoms were experienced by 



the patient. In order to fully satisfy myself of the 
truth of my patient's statement, I called on his brother 
and f jund him in a convalescent stage of variola, the 
pustules having mostly broken and formed scabs. 

The success of this case encouraged me to put my 
h3'potliesis to a still further lest. During the course of 
the epidemic, eight other cases of the same nature pre- 
sented themselves, the details of which are not necessary 
to describe. Suflice it to say that in each and every 
case the contagion was fully established. The result in 
each case was precisely the same as in the first case 
related above. In two cases the fever stage had lasted 
fully two days, as in the first case. In the others the 
fever had continued from twelve to thirty-six hours. 

In one case only, the result was unfavorable. The 
fever in this instance had continued for nearly three 
days, when the inoculation was performed. A few 
hours later the eruption made its appearance all over 
the body, and the case proved a discrete one. I can 
scared)' assume that vaccination exercised any modify- 
ing influence, f ince no vesicle was reported to have made 
its appearance (the patient being under the care of 
another physician), yet the possibihty of such an event 
cannot be denied. 

As regards the modus operandi of the virus at this 
stage, I cannot look upon it as different from that of an 
ordinary vaccination. A good absorbing surface being 
produced, and the virus introduced in a state fViVorable 
to absorption, it is readily carried into the circulation. 
Ca[)illary circulation being very active during the fever 
stage, as evidenced by the thermometer, seems to me to 
favor the absorption of the virus. This may in some 
measure account for the unusually rapid appearance of 
the vesicle. It is not my intention to speculate with 
regard to the action of the virus in the system. Whe- 
ther it acts as a ferment, or, in some manner unknown, 
attracts the poison within the system to that particular 
spot, are mere matters of speculation. It is a well- 
known fact that counter-irritation, as for instance the 
application of croton oil to some particular part of the 
body, as the chest, has the effect of determining the 
eruption to that neighborhood. 

If we choose to consider a local point of irritation a 
favorable spot for the eruption, the question will be 
solved as fur as speculation can solve it. The fact that 
at that point the skin has been removed and the corium 
exposed, will render the spot a "locus rainoris resis- 
tentise" for the eruption. 

I think that the results of these experiments will 
justify me in calling the attention of tlie profession to 
them. My excuse for presenting so limited a number 
of cases, lies in my inability to put it to a further test, 
owing to want of material. Nevertheless, I do not 
hesitate to affirm that vaccination, properly j)erformed, 
previous to the exacerbation of tltejfever on tlie third day, 
will cut short the disease, hy quickly relieving the general 
symptoms of small-pox, and causing a icell-marked erup- 
tion on the spot inoculated. 

It must be borne in mind that the fever accompany- 
ing variola is of a remittent type, and, like all remittent 
fevers, has its highest range of temperature in the even- 
ing. The third, and usually the last exacerbation, is 
also the most severe (marking the highest temperature), 
and quickly followed or rather accompanied by the 
eruption. Vaccine virus introduced during this last 
remission will scarcely have time to be absorbed, though 
it is possible that when absorbed it may mitigate the 
character of the eruption. Of this, however, no positive 
proof exists, and it is merely mentioned as a possibihty, 
if not a probability. 

In inviting the attention of my colleagues to this 
important matter, I cannot refrain from requesting a 



12 



THE MEDICAL RECORD. 



strict observation of llie ordinary cautions in further 
testiiip the results of vaccination during tlio fever stnpc 
of variijla. That the virus sliould be pure, unmixed 
with Mood, and not too old, need scarcely be mentioned. 
For my part I have loimd tiie recently dried scab, ex- 
clusive ol the inllammatory products on the perii)hory, 
rubbed up carefully with a drop of water or glycerine 
to a creamy consistence, to answer the purpose admira- 
bly. Various ages and various physicians have had 
their own peculiar method of introducing the virus, 
either by punctures of the skin or liy scraping away 
the cuticle. Punctures of the skin, whether performed 
by the lancet, a pin. or some instrument invented fi)r 
the purpose, are open to two objections. In the fust 
place, tlie [»uncture will close immediately upon the with- 
drawal of the instrument. Even when the virus is 
introduced with the pvmcturing instrument, the appli- 
cation is too .sudden to insure absorption. In the second 
place, it often occurs that, notwithstanding proper care 
is taken, blood will follow the puncture. Extravasated 
blood is verv slowly reab-orbod, and tlicrefore a hin- 
drance to absorption of the virus when the latter be- 
comes mixed with it. 

In my opinion, scraping of the cuticle with a dull 
lancet until the coriuin is exposed, i.s, although a more 
laborious, afar more certain method. The first appear- 
ance of moisture on the scraped spot is an indication of 
having reached the proper absorbing surface. It is well 
not to be too sparing in the application of the virus, but 
to spread it upon the absorbing surfaces (for there 
should be two) as thickly as possible. 



A CASE OF RECOVERY FROM DIPHTHE- 
RIA AFTER THE OPERATION OF 
TRACHEOTOMY. 

Reportkd by GURDON BUCK, M.D., 

NEW TOBK. 

Visited Ricliard, son of James H., pot. 10, residing 
No. 8 Dover st., at four o'clock p.m., Nov. 28, 1871, by 
request of Dr. C, his attending physician, and found him 
suffering from very urgent and increasing dyspnoea; 
his voice was reduced to a whisper ; cough was croupy ; 
pulse frequent but regular; surface perspiring freely 
from the labor of respiration. He had been frequently 
vomited by medicine the preceding night, but without 
relief; croupy symptoms had existed tor two or three 
days, and had become urgent within twenty -four hours. 
It was reported by his father that his physician had not 
found any exudation in the fauces. For some reason 
not explained, the attending physician did not appear 
at the hour appointed. After waiting a reasonable time 
I decided, in view of the extreme urgency of the symp- 
toms, to proceed to operate. Fortunately the attend- 
ance of Dr. A. J. Harrison, who had visited the patient 
once, was R?cured without much delay. A narrow table, 
covered with suitable bedding, answered the purpose of 
an operating table. Four sperm candles cut into halves, 
and bound with tape into two bundles, served as lights 
that could be conveniently held at any point where 
they were required. No anaesthetic was administered. 
The boy's father held his head, and kepthis neck on the 
streteh, while his godmother held the torchlights. The 
embarrassment of having only one medical assistant for 
the operation was felt at every step. The only feature 
of the operation to which the author would call atten- 
tion is the expedient employed to facilitate the opening 
into the trachea itself. Two accidents are liable to 
occur in this step of the operation. One is, the incision 
may deviate from lh3 median hne; the other, failing 



to penetrate into the interior of the trachea, the knife 
may pass either between the outer surface of the tra- 
chea and it.s coverings, or between its inner j-urface and 
lining membrane. The procedure was as follows: An 
ordinary pocket-ease tenaculum was thrust between the 
cricoid e.utilage and first tracheal ring, exa<"tly in the 
median line, .-ind made to hook up the cricoid, thus 
Serving to maintain a .'^ecure hold upon the trachea, and 
keep it at rest. While the tenaculum was held witli 
the left hand, a sharp-pointed knife, held in the right, 
was made to |)enetrate the trachea immediately below 
the entrance of the tenaculum, and an incision was car- 
ried downward through the four upper tracheal rings. 
The knife, without being withdrawn, was immediately 
carried back to the point of entrance, and a tran-sverse 
cut two lines in length was made on either side between 
the cricoid cartilage and first tracheal ring, giving the 
tracheal opening the shape of a letter T. A double tra- 
chea tube, previously armed with a piece from the 
blunt end of a gum-elastic catheter traversing it, and 
with its l)lunt point projecting a little bev'^ond llie inner 
end of the tube to serve as an obturator, was then 
inserted and secured with tapes passed around the 
neck. After the disturbance, always consequent upon 
the first introduction of a tube, had subsided, the res- 
piration became tranquil and the patient soon fell into 
a placid sleep. Instructions were given for the re- 
moval and replacing of the inner tube as often as it 
required cleansing. About three hours after the opera- 
tion the tube became obstructed by a coagulum, and 
the parents not succeeding in removing the inner tube, 
suffocation would have taken place had not Dr. Harri- 
son fortunately reached him in time to dislodge the 
inner tube, which he did by prying it out with a knife- 
blade. 

During the subsequent forty-eight hours the respira- 
tion continued easy, and his general condition satisfac- 
tory. At my visit in the afternoon of Nov. 30, how- 
ever, I found his respiration hurried and labored, and 
it had been so for two hours. The tube had been kept 
clean and free of obstruction. The outer tube was now 
removed for the first time to cleanse it and change the 
fastenings. This permitted a view of the wound, the 
surface of which was found coated with a layer of gray- 
ish tenacious exudation, not, however, pellicular. From 
this appearance the diphtheritic nature of the disea-e 
was obvious, and it was inferred that a similar exuda- 
tion was obstructing the air-passages and producing the 
dyspncea from which the patient was siiftering. After 
replacing the outer tube, and .supporting (he patient in 
a semi-sitting posture, a solution of common table salt, 
in the proportion of one teaspoonful to a teacupful of 
warm water, was poured into the trachea through the 
tube, one teaspoonful at a time, and at intervals which 
allowed the immediate disturbing effect of it to subside. 
A violent cough was immediately provoked by the en- 
trance of the fluid, accompanied by the expulsion of a 
quantity of the viscid secretion in a diluted state. Five 
or six teaspoonfuls were thus introduced in succession, 
when he became somewhat exhausted by his efforts in 
coughing. While supported in a half-sitting posture 
his breathing soon became easy and unobstructed, and 
continued so without any subsequent recurrence of 
dyspnoea. He continued to cough more or less, but a 
good night's sleep followed. The next day he was 
found doing well ; his pulse reduced to 100 ; his surface 
natural ; his countenance animated, and his spirits cheer- 
ful. Inspected the fauces, and found no diphtheritic 
exudation in sight. He craved solid food and enjoyed it. 

Ordered R. Sulph. quinine, sulph. ferri, 32 3 ss. ; acid 
sulph. aromatic. Ij.; syrup zingib. | vij. ; aquae cinnam. 
5 ij. Dose, 3 j. ter in die. 



THE MEDICAL RECORD. 



13 



Dec. 2. Doing well. Removed and replaced the tube, 
and found the surface of the wound clean and liealthy ; 
appetite good. 

Dec. 3. An urgent message summoned me to visit 
him at iialf-past five o'cloc-k p.m. A hemorrhage from 
the wound, represented as very considerable, had taken 
place and alarmed the parents. His pale countenance 
and feeble pulse (SO per minute) showed the ellect of 
the loss of blood. A thorough examination of the 
wound, the surface of which was pale, could detect no 
vessel. Tlie occurrence of the hemorrhage Avas the 
more remarkable as. at the operation, the bleeding had 
not been considerable, and no vessels had required to be 
ligated. 

Dec. 4:. No recurrence of hemorrhage; doing well; 
respiration natural and easy ; appetite good. 

I)ec.. 7. Progress favorable. With the tube left out 
and the external wound closed by the fingers, patient 
could articulate some words in a natural tone of voice. 
I therefore substituted a fenestrated single tube for the 
double one, and closed the outer end with a cork, thus 
allowing him to use his voice and to breathe through 
the larynx, which he did without eflbit. 

Dec. 9. Patient passed the day without a tube. The 
lateral edges of the wound have come into contact with 
each other, so that the air no longer escapes through 
the wound; respiration is now pei'foi'med per vias na- 
turales. His voice has still further improved. His 
cough continuing troublesome at night, the following 
mixture is prescribed: — 

1^. Ext. senekse fluid. ) -. , .. 
Tinct opii camph. ( ^' -* J- 
Spirit nitri dulc, 3 ss. 
Syrup balsam tolut., 3 ij. 
M. Dose, "j. pro re nata. 

The follow-ing preparation in the form of spray was 
freely used throughout the whole treatment alternately 
Avith hme water, and apparently with good efiect : — 

5. Ammon. muriat. } -- _ •• 

Potas. chlorat. f '^'^ ^ ^^■ 

Tinct. seneka3, 3 j. 

Aquic ros8e, 5 iv. 
M. 

Jan. 11, 1872. Patient was visited, and found in all 
respects well. His voice had regained its full force. 



OVARIOTOMY. 

TREATI.VG THE PEDICLE WITHOUT CLAMP. LIGATURE, OR 
CAUTERY. 

Being a Taper read at the Meeting of tlie Medical Society of the State 
of New York, held Feb. 7, 1872. 

By JULIUS R MINER, M.D., 

* BUFFALO, N. Y. 

Gentlemen — During the past few years I have been 
led to make some observations as to the anatomical 
characters of ovarian disease, and to base upon those 
observations, and a few clinical facts which have come 
to my notice, the conviction that ovarian tumors — 
cystic disease of the ovary — can be removed by e/iuclea- 
tion, without ligature, clamp, or cautery. All other 
steps in ovariotomy have been pretty Avell settled; 
this one alone, of hoAV to treat the pedicle remaining 
subject to the caprice of the operator, directed by no 
well-defined rule or law. Without attempting to enu- 
merate the objections which may be fairly urged 
against all previous plans of procedure, allow me to 
describe a neio method, which, I am now led to believe. 



will in all, or nearly all, cases be found feasible, and if 
so, is in every respect satisfactory. 

My first observation and experience in this procedure 
occurred in April, 1809, and the case was reported in 
detail in the Jit(ffalo Medical and Sunjirul Journal for 
June of the same year. It was described as follows : — 
" A few months since I was invited to remove an im- 
mense ovarian tumor, occurring in the person of Mrs. 
Foster, of Cattaraugus County, N. Y. It was of a year's 
standing, had been repeatedly tapped, but at length 
the contents proved to be too thick to be drawn 
through the largest-size eanula; and the distress becom- 
ing too great for endurance, any operation which 
would end it, whatever might be the result, was gladly 
accepted. The tumor was inultilocular, very large, 
weighing, as near as could be determined, nearly one 
hundred pounds. It was attached throughout its en- 
tire circumference to the omentum, intestines, walls of 
the abdomen, and all other parts with which it came 
in contact. These attachments were not so firm but 
that they could be broken up, and with great care the 
tumor was separated from the surounding parts until 
the pedicle was reached. The process of enucleation 
had been carried on so successfully and so extensively 
that encouragement was afforded for continued trial : 
the pedicle was large, and extended over a wide surface, 
but by careful and patient effort it was separated fiom 
its entire attachment to the tumor, and tlje immense 
growth removed without (he ligation of a single vessel. 
The terminal branches of the vessels of the pedicle 
gave out no more blood than issued from the vessels of 
the attachment elsewhere, and there appeared no more 
occasion for ligature here than elsewhere. All hemor- 
rhage soon ceased, and the incision was closed by inter- 
rupted suture." 

The success of this procedure was complete, and the 
patient continued for more than two weeks to improve 
without an untoward symptom — so long that her re- 
covery seemed certain. She now commenced to lose 
her relish for food, grew weak and desponding, and 
died fiom exhaustion on the twenty-first day afier the 
operation. The fatal termination detracted nothing 
from the success of this mode of treating the pedicle ; 
indeed, so remarkable Avas the size and attachment of 
the tumor, tliat any attempt at recovery is surprising, 
and yet the feeble, emaciated, exhausted patient con- 
tinued to live long enough to show tliat the manner of 
treating the pedicle was, at least in her case, unobjec- 
tionable. 

My second opportunity to test the feasibility and 
safety of the plan I liad suggested presented itself in 
the Buffalo Greneral Hospital, in December of the same 
year, in a German woman sixty-six years old, of feeble 
and delicate appearance, and considerable emaciation. 
The operation was made iu presence of the students of 
the Buffalo Medical College, and I was assisted by my 
colleagues both of the College faculty and hospital staff. 

This tumor was found also extensively attached to 
the walls of the abdomen, and the process of separation 
Avas conducted as before, the bands of attachment being 
separated from the fibrous cj'st of the tumor, not torn 
or broken. On reaching the pedicle it was found 
large, its principal arteries throbbing distinctly. It 
Avas separated readily by enucleation, commencing at 
its central attachment, and folloAving out the fasciculi 
of vessels to their final termination upon the Avails of 
the tumor. Upon removal, it was found to Aveigh 
seventy-one pounds, and to be composed of numerous 
cysts. The bands of vessels composing the pedicle, 
when separated from the tumor, contracted so as to 
leave the pedicle appearing almost as if it had been 
divided Avith the knife. To the sui-prise of my asso- 



14 



THE MEDICAL RECORD. 



ciate-i, scarcely any homorrhnjre followed the separa- 
tion, much los^ than attended the separation of tlic 
bands of attachment cNewhere. This i)niient was nar- 
cotized hy ?nbcutaneous injection of morpliine given by 
my Hospital Assistant. She died eighteen hours after 
the operation. Post-mortem examination .showed no 
hemorrliage or other explanation, and we inferred that 
death was from overdose of n)orpliii)e. 

My friend and eclle.ngue Prof James P. Wiiite, of 
Buffalo, has since made succes-fid trial of tliis plan of 
operation — that is, successful sd far as removal by enn- 
cleation witliont hemorrhage is concerned. He in- 
forms me that there was less hemorrhage fron) the 
pedicle than from otlier places of attachment; and that, 
though he finally applied ligature, he did not do it 
from nece.«.sity, but rather from fear of its occurrence 
after reaction should take place. Other similar cases 
might be related, but I prefer to refer brictly to the 
experience of others, in confirmation of my own obser- 
vations. Richard H. Meade, Esq., Consulting Surgeon 
to the Bradford Infirmary, England, thus speaks upon 
the subject: — 

"The patient being under the influence of chloro- 
form, I made an incision about four inches long in the 
lower part of the linea alba, carefully opened tlie peri- 
tonreum, and evacuated nearly two gallons of ascitic 
fluid. On enlarging the opening in the peritonteum to 
the same extent as the external wound, the ovarian 
tumor at once came into view. I now' directed an 
assistant to compress the abdominal walls with his 
hands, one placed on each side, so as to compress the 
edges of the wound backwards, while I endeavored 
Avith my hands to draw the tumor partially through 
the opening. In doing tliis, the walls of several of 
the small cysts, of which the tumor was principally 
composed (being very thin), were ruptured by the 
pressure of my fingers, and a considerable quantity of 
thick, brown fluid, like dark-colored linseed tea, 
escaped. The edges of the Avound were so well 
compressed that none of this ovarian fluid was allowed 
to enter the peritoneal cavity. The tumor was now 
found to be firmly adherent to the free extremity of 
the great omentum ; these adhesions Avere carefully 
and slowly torn through, and the whole mass was 
then easily drawn through the wound. It was now 
found to contain a good deal of heav}', solid matter, 
and, on turning it over to examine its attachments, 
the pedicle, which was small and thin, to my dismay 
and annoyance at the time, gave way, and the tumor 
tore itself loose from its connections. Fearing hemor- 
rhage, I kept hold of the remains of the pedicle, but 
very little bleeding followed, and I could jBlnd no vessel 
requiring ligature. 

" It is difficult to account for the large quantity of 
ascitic fluid which was met with, unless there were 
some secondary deposits of cancerous matter on the 
peritonaeum, but the history of the case Avould hardly 
lead to that supposition. The pre=ence of a consider- 
able amount of serous eOusion in the peritoneal cavity 
has, however, one advantage in cases of ovariotomy — 
it seems to render the membrane less likely to take on 
acute inflammation, its delicate secreting surface having 
undergone some change, and after the removal of the 
ovarian disease it does not seem to be re-secreted. 

" In some of the medical journals a case of ovariot- 
omy has be?n reported (extracted from an American 
periodical), in which Dr. Julius F. Miner removed a 
very large ovarian tumor by enucleation, without either 
clamp, ligature, or cautery, and without hemorrhage. 
When I commenced the above operation I iiad no 
idea of imitating his proceeding, but when the tumor 
(to my horror at the time) enuclea:ed itself, and there 



appeared to be no bleeding from the pedicle, I deter- 
mined to follow his example, and leave the torn 
surface unsecured, thinking that the ri>k from hemor- 
rhage was less than that from inflammation from the 
presence of a foreign l)ody in the peritoneal cavity. 
My ca.se turned out successfully, and I think I .should 
venture to repeat the proceeding in .some special cases — 
for instance, Avhere the pedicle does not appear to be 
vascular — when the attempt might be made to tear the 
tumor gently from its connections fin the same way 
as adhesions are generally separated), but a firm hold 
should be kept of the pedicle, so that it might easily 
be secured in case of bleeding." — liritish JfedicalJour- 
nal. — limithiraile's Retrospect for July, 1871. 

Upon these fact-* I based the conclusion that the 
pedicle in ovariotomy can be safely separated from the 
cyst, and left without ligature, clamp, or cautery, thus 
avoiding many dangers attending it. At first this 
proposition Avill appear startling to surgeons who have 
tied large vessels in the operation, or have witnessed 
the fearful hemorrhage which sometimes takes place 
from slipping of clamp or ligature; these will regard it 
with incredulity, and, perhaps, Avithout trial look upon 
it as wholly impracticable. I should myself, probably, 
be among this number, had I not had opportunity to 
demotistrate to my own mind, certainly, its entire 
feasibility. 

The ovarian tumor is composed of a firm, dense fibrous 
cyst, containing fluid of varied color and composition. 
It may, and it may not, have a solid portion, but usu- 
ally it docs haA'e more or less of a body, the remnant 
of an enlarged or degenerated gland. Upon the surface 
of this smooth, dense fibrous cyst are spread out the 
vascular and cellular tissues which compose the pedicle, 
but only the terminal branches of the vessels enter this 
cyst; the vessels may be quite large at their origin, 
but soon they are numerously divided, and enter the 
cyst, if at all, of capillary size. The attachment of the 
pedicle to the cyst is more easily broken than any one 
Avould mistrust who has not attempted its separation 
in the manner described, and I am confident that the 
same efforts Avhich are made to break up the adhesions 
to the peritonaeum, omentum, and other parts, if ex- 
tended to the pedicle, anmII be equally successful. The 
finger should be gently introduced under the centra! 
portion of the pedicle, and followed out along the fasci- 
culi of A'essels as they extend over the sides of the cyst; 
nothing can be more easy of execution or more readily 
accomplished. 

If this method can be adopted without hemorrhage 
or other difficulty, its advantages are apparent. 

The pedicle can then be returned into the abdominal 
caA'ity Avithout any of the objections which have been 
urged against this procedure. There is no ligature to 
be discharged by the ulcerative process, or to become 
encysted, or to induce inflammation. There are no 
purulent or inflammatory products to be in any way 
removed or provided for ; the pedicle is wholly a living 
tissue, and h.TS no irritative qualities which render its 
return to the abdominal cavity objectionable. This 
cannot be said of it when treated by any other knoAvn 
method. 

My object will be fully answered, provided the feasi- 
bility of enucleation in OA-ariotomy is shown with suffi- 
cient clearness to obtain trial by surgeons. It is now 
believed that all or nearly all cases will admit of it, or 
of this general plan at least, perhaps varied to suit cir- 
cumstances ; and that, Avhere practicable, it is the least 
objectionable of all known methods. Prof. E. M. Moore, 
my colleague, has suggested that if alter separation, as 
described, there is any slight or troublesome hemor- 
rhage, the different fasciculi, or the various parts which 



THE MEDICAL RECORD. 



15 



have extended over the walls of the cyst, may be braid- 
ed, causing in that manner arrest of hemorrhage upon 
the principle of acupressure. Again, provided this meth- 
od in any case should fail, the plan of arresting hemor- 
rhage by acupressure or torsion, or separate ligation of 
any vessel which might seem to require it, witli thread, 
silver Avire, or other material, may yet be tried, may 
indeed be adopted as aid to the operation by enucleation. 
The advantages of this procedure are sulficiently 
obvious to all surgeons of experience in this operation; 
and the feasibility of the method being granted, little 
else need be said to insure its universal adoption. 



(Driijinnl Cccturcs. 



SCLEROSIS UTERI: 

ONE OF THE SEQUELS OF PUERPERAL METRI- 
TIS. 

A CLINICAL LECTUKE, 

By Prof. ALEXANDER J. C. SKENE, M.D., 

AT THE LONG ISLAND COLLEGE HOSPITAL. BROOKLYN, N. Y. 

(Reported by K. S. Bunker, M.D.) 

Gentlemen: You will readily call to mind the patient 
who had endometritis, giving rise to monorrhagia, and 
I trust you also remember the clinical fact, then so 
strenuously insisted upon, namely, that menorrhagia, 
not accounted lor by any other conditions, is a common 
and most valuable symptom of endometritis. 

In direct and striking contrast with that case, I 
present you one to-day, not of such frequent occur- 
rence as the former, but presenting, nevertheless, 
points of extreme interest in its pathology and clinical 
history. 

This patient informs us that she is 35 years old, has 
been pregnant five times, and has given birth to four 
living children. While j^regnant at the seventh month, 
with her fourth child, she received an injury which 
caused her to give birth to a dead foetus a few days 
afterwards. 

During her fifth pregnancy, four years ago, she 
received a shock from seeing a friend in a convulsion ; 
labor came on immediately, and she was delivered of a 
seven months' child. 

Soon after her confinement she complained of pain 
and tenderness in the region of the uterus, followed by 
fever and delirium. These sjanptoms extended over a 
))eriod of three weeks, and there can be little doubt, 
from the history given, that she had acute puerperal 
metritis, which lelt her health permanently impaired. 
Since that time her menses have been irregular, scanty, 
and attended with pain. At times she has a menstrual 
molimen, but no catamenial flow. During the last year 
she has menstruated only twice, the last time three 
njonths ago. So much for the previous history of the case. 

She now suffers from extreme debility and anaemia, 
as you can see by her general appearance, and com- 
plains of ill-de6ned aching pains throughout the pelvis, 
but more especially in the sacral region ; and occasion- 
ally she has very slight leucorrhoea. Her digestive 
organs are also very much deranged, and her nervous 
system, from the joint action of disease and drugs, is a 
miserable wreck. 

By physical exploration I find that the uterus is en- 
larged, being an inch larger than normal. The body 
and cervix are tender to the touch, and the sound, 
carried into the cavity, gives extreme pain. The cer- 
vix is indurated and smooth, and the os is smaller and 
more circular than is usually found in those who have 
borne children. 



Exploring the cavity with the sound, I find that 
while the long diameter is considerably increased, the 
antero-posterior and lateral diameters are relatively, 
indeed absolutely, shortened. The uterine walls ap- 
pear to lie in close contiguity, so that it is impossible to 
turn the sound far in any direction. 

These signs obtained by the probe are of vast impor- 
tance, for they indicate clearly that the enlargement of 
the uterus is due to an actual increase in the loalls of 
the organ, and not a mere expansion of its cavity, as in 
the case of endometritis, which I showed you the other 
day. In other words, the growth is concentric, not 
eccentric. 

The cervix, as seen through the speculum, is notably 
pale; the os is small, with its lips curved inward. This 
retraction, or drawing inwards of the os, is confirmatory 
of the opinion that the Avails of the cervix are enlarged 
more than the mucous membrane of the cavity. When 
the mucous membrane of the cervix is swollen, and the 
walls remain normal, the lips are enlarged or pouting. 

Briefly, then, the physical signs indicate that there 
exists a condition of unusual hardness and enlargement 
of the uterine Avails, while the relative or even actual size 
of the cavity is lessened. The uterus is also anaemic, as 
you knoAV from a glance at the cervix. And, before 
closing the history, let me attract your attention to the 
fact that our patient has amenorrhoea — a condition that 
is much more common among the young than Avith 
those AAdio have borne children. 

NoAV you cannot fail to have observed that this case 
presents many points of resemblance to that of endo- 
metritis, AA'hich occupied your attention at our last lecture. 
It is on account of these resemblances that I present 
you this case to-day. By placing them in juxtaposition, 
as it Avere, AA'hen the subject is still fresh in your memory, 
you Avill be better prepared to study the points of dif- 
ference; for both the past history and the present con- 
dition shoAV that the cases are essentially different. 

This patient's trouble began Avith acute inflammation 
of the uterus; the other's did not. This one had 
amenorrhoea; the other had menorrhagia. In the case 
before us the uterine Avails are enlarged and the cavity 
diminished, the reverse almost of Avhat obtained in the 
the other. The uterus, in this case, is indurated and 
anajmic ; in the other it Avas relaxed and highly con- 
gested. These are plain outline distinctions, easily 
recognized at the bedside, and characteristic of almost 
opposite pathological conditions. 

Excluding, then, the only uterine disease that might 
lead us into error, and basing our opinion on the clinical 
history and physical signs, Ave are compelled to pro- 
nounce this a case of Avhat is usually knoAvn and 
described as " cJtronic metritis." 

But I fear the term "metritis" will lead you astray. 
It certainly does not give you a true idea of the patho- 
logy of the disease — at least, if you recognize inflamma- 
tion only by the presence of hyperemia, the exudation 
of lymph, suppuration, etc. In this case Ave have no 
such evidence of the inflammatory process; the present 
condition is not that of an inflammatory disease. It 
bears no more resemblance to ordinary inflammation 
than the stricture of the male urethra does to an acute 
gonorrhoea. Nor is the condition that of induration 
the result of the inflammatory process. That usually 
results in the contraction as well as hardening of the 
tissue in Avhich fibrin is effused. Noav, in the case 
before us, you Avill observe tAVO conditions not often 
associated except in malignant disease, namely, hard- 
ening with increased size of tissue. Clinically considered, 
this condition is not unfrequently obser\-ed associated 
Avith a history and symptoms such as Ave gather from 
this patient, and in the absence of any name to indicate 



16 



THE MEDICAL liECOliD. 



the condition. I venture to suggest that of HclfrusU — a 
term nlroaily fiuniliar to you aMlesi'^niiting morbid con 
ditions of other organs similarly allectfd. 

I conii'ss to you my dislike to introducing new terms 
into tlie literature of gyna3cology, and certainly would 
not if I did not think the one usually eni|iloyed, namely, 
''chron c metritis," gives no true idea of the nature of 
the lesion. 

The term sclerosis simply moans hardening, and when 
applied to the inter-cellular connective tissue, it includes 
also thickenitig or growth of this structure. It resL-mbles 
the condition described by Virchow as ''nutritive irri 
tation of connective tissue." Your knowledge of 
anatomy will enable you to estimate the relations of 
this tis-ue to the varied structures of the body. In its 
normal stale it is an exceedingly delicate structure, and 
is e.vteiisively difl'used in all parts of t!ie body. It is 
the bond of union to the framework of the body as the 
plaster is to the bricks; it is the delicate curtain upon 
which the minute capillaries are spread ; and it follows, 
of course, that the increased growth of this connective 
tiisue takes place at the expense of the fibro-muscular 
tissue of the uterus, a condition of local anieinia is pro- 
duced b}' pressure on the capillary vessels, and I need 
scarcely add that function and force are correspondingly 
destroyed. This lesion has been specially studied of 
late as it occurs in nerve-centres. Hypertrophy of the 
" neuroglia," or connective tis.sue in patches, gives rise 
to a condition resembling locomotor ataxia. 

Now the result of this same proliferation of the con- 
nective tissue cells, from some previous spur of excite- 
ment, is precisely what we find in this uterus. We 
have the '* nutritive irritation" of Virchow, all'ecting the 
connective tissue cells at the expense of the other 
structures of the part, and not simple induration from 
previous inflammation. The organ is rendered ab- 
normal in size, dense in structure, brittle in quality, and 
is anaemic or bloodless. 

In tlie older pathology we have no word that repre- 
sents this condition. We can scarcely believe that the 
process is merely one of exudation of lymph into the 
tissues of the uterus, for that is usually followed by 
more or loss contraction ; nor can we for a moment 
believe that there is excessive cell-growth from mahg- 
nant tendency. Thanks to our German brethren, they 
have pointed out and accurately described the lesion, 
and applied to it the name of "sclerosis." And no 
other term, in my judgment, so perfectly represents a 
certain class of uterine diseases, a typical case of which 
is now before you. 

I would not be understood, however, as denying 
that there is inflammatory exudation. On the contrary, 
there is every reason to suppose, from the natural his- 
torj' of the disease, that there is more or less effusion 
of inflammatory lymph into the tissues of the uterus. 
But the hypertrophy of the cellular tissue, and conse- 
quent enlargement of the organ, are so much more 
prominent characteristics of the disease, that I have 
selected the term .sclerosis, rather than metritis, to 
describe it. 

It would be interestiu:? in this conned ion to study 
how the lesions of sclerosis uteri are developed in 
their natural order of sequence; but time will not 
permit at present. Let me refer you for information 
on this point to a most admirable article on " Chronic 
Metritis in its Relaiiuns to Malignant Diseases of the 
Uterus," by Dr. Xoeggerath, of Xew York. You will 
find it in the American Journal of Obstetrics for Novem- 
ber, 1869. I will read you a brief extract : — 

'• The disease in question is the combined result of 
sub-involution of the uterus, and a process of exudation 
which takes place in the tissues of the uterus immedi- 



ately after delivery, in consequence of puerperal fever. 
This int'Trui)tion of retrogressive metamorpho.-is takes 
place whenever the natural involution of the uterus is 
interfered with by some injurious influences, so tha! 
the absorption of the exuded mass depof-iied between 
the muscular elements cannot be properly accomplished. 
This results in the development and permanent deposit 
of cellular tis-iue within thj walls of the utern.«." 

Just here there comes up a question to which I can 
give but a single remark at jiresent: Doe^ .'■clerosis 
uteri arise exclusively from puerperal metritis? Or 
may it be developed from other morbid influences ? Dr. 
Noeggerath sa^'s he has never seen the disease occur a.s 
a sequel of any other afifection. My own experience 
accords with his. We should naturally suppose, how- 
ever, that long-continued hyporaemia and nervous irrita- 
tion might favor the proliferation of the connective 
tissue cells in tlie uterine walls, as well as elsewhere; 
but we have no proof as yet that sclerosis uteri is de- 
veloped in that way. 

Finally, sclerosis uteri is a permanent lesion. There 
is no tendency to restoration of normal tissue; on the 
contrary, there is lowered vitality of the part, and con- 
sequent tendency to still further degeneration. The 
afiection exemplifies the general pathological law, to 
which there is no exception, that whenever the tissues 
of an organ are changed from their normal type, that 
change is towards degeneration, decay, and death. 
Hence the practical fact that these cases of ."Jclerosis are 
peculiarly prone to such diseases as epithelioma, cauli- 
Jlower excrescence of the cervix, etc., etc. 

Malignant disease of the uterus can often be traced 
back through a natural history such as I have pointed 
out in this case; and that the tendency to malignant 
action is hastened in such cases by the injudicious use 
of caustics, I have no doubt. It is important, there- 
fore, that we shall early recognize the difficulty and 
avoid a course of treatment that must end, sooner or 
later, disastrously to the patient. 

Trusting that you comprehend the pathology of scle- 
rosis uteri and its relation to other morbid states, I will 
now briefly recapitulate some of the leading points in 
the diagnosis of this affection. 

1. A clinical history indicating that the patient has 
previously had puerperal metritis, followed by an im- 
paired sUite of health. 

2. Constitutional symptoms such as occur in chronic 
forms of uterine disease. 

3. Derangement of function: usually irregular, 
scanty, and painful menstruation. The pain continues, 
as a rule, through the whole period of menstruation, 
and may be likened to an exaggeration of the ill feelings 
of an ordinary menstruation. By these peculiarities it 
may be distinguished from the dysmenorrhoea caused 
by flexion of the uterus. In this latter afifection the 
pain is that of intense uterine colic, and is usually 
limited to the beginning of menstruation, decreasing or 
disappearing when the flow begins. 

4. Enlargement and induration of the uterine wall?. 

5. Increased length of the uterine cavity, without 
increase of the lateral and antero-posterior diameters. 

6. Ansemia of the uterus, indicated by the amenor- 
rhoea, and the pale appearance of the cervix. 

7. Absence of cervical disease, such as occurs in hy- 
peraemic and inflammatory aflfections. 

8. The slight retraction of the lips of the os, and the 
small diameter of the cervical canal in proportion to the 
increased size of the cervix. 



THE MEDICAL RECORD. 



17 



The Medical Record: 

A SEMI-MONTULY JOURNAL OF MEDICINE 
AND SURGERY. 

GEORGE F. SHRADY A.M., M.D., Editor. 



Published on the Isl and \^lh of each Month by 
WOT. WOOD & CO., 27 Great Jones Street, N. Y. 



]SreAV ^^ork, INIarcli 1, 187; 



THE RELATIVE mOREASE OF POPULATION. 

ALTHOUGn the subject of the relative increase of popu- 
lation among the higher and lower orders of society is 
one of vast importance, yet it has been terribly neg- 
lected. While men are discussing the great question 
of the rise and fall of nations, they seem to ignore the 
one great fact, where the men of which nations are 
made are to come from. 

Dr. Nathan Allen, of Lowell, is one of the few who 
have given the subject a scientific and patient attention. 
He has studied the subject as it ought to be studied, 
statislically ; and he has discovered th'at the average 
number of children to American families in New Eng- 
land is but three, or three and a half, against an average 
of eight to families of a corresponding social scale a 
century ago. Population can hardly be kept up among 
the cultivated classes, unless an average of more than 
three children are born to a family. This, then, is 
the great problem of the future ; it is a problem 
which no nation and which no government has yet 
solved. Historians have long debated the question, 
what was the reason for the decline of Greece and 
Rome. Prof. Seelye, the eloquent author of Ecce 
Homo, has answered this question : " Rome died for 
want of men." " The human harvest was bad." 

Dr. Allen, in a very suggestive paper, based on Prof. 
Seelye's essay on ^^ Roman Imperialism," has shown by 
quotations from standard authorities that, in all proba- 
bility, Greece died for the same cause as Rome. The 
nation died because the individuals that composed it 
died, and there were none to fill their places. The 
most pertinent fact concerning these statistics is, that 
they are in the main true (for Dr. Allen's opponents 
have made no headway against him), and they are con- 
firmed by common observation. Practitioners in New 
York and vicinity tell us that they find not more than 
an average of three children in a family. Among the 



higher classes, very few families have more than five 
children, very many have but one, and altogether too 
many have none. 

We should be glad to hear from practitioners in the 
country their views on this matter. A nation can do 
without high culture; it can do witliout extensive ter- 
ritory; it can do for a lime without religion; it can. like 
China, do without a pure morality, but human beings it 
must have. Questions of science, of education, of gov- 
ernment, of religion, of morality, etc., are trifles com- 
pared with this one great question of population. Un- 
less we are greatly in error, the population in distant 
country-places increases among the higher classes much 
more slowly than it did one hundred years ago. The 
time must come when the labors of Dr. Allen and the 
few interested in this matter will be appreciated, when 
their errors, if they have made any, will be corrected, 
and the whole subject will be scientifically investigated. 
The time must come when physicians will evince a dis- 
position to employ a portion of their leisure in studying 
the great laws of population. 



THE PROPOSED DRUG EILL. 

The Drug Bill now before the Legislature has been 
modified in several important particulars which will, 
we doubt not, render it even more acceptable to the 
pharmacists of our city. Instead of the several 
grades already mentioned we have now but two, viz., 
graduates in pharmacy and licentiates of pharmacy. 
The former grade comprises all those Avho hold diplo- 
mas from recognized colleges of pharmacy, and the 
latter includes such as have not enjoyed the privileges 
of these educational institutions, but who have obtained 
a license from the present board, or who shall pass the 
examination before the proposed new board appoint- 
ed by the members of the New York College of Phar- 
macy. The other grades are, so to speak, abolished, 
and in their stead simple assistants are named who 
are only responsible through their principals. It is 
also provided that these so-called apprentices shall have 
served with some practical pharmacist four years be- 
fore they shall be eligible for examination as licentiates. 
The provision for an annual registration is also abolished, 
as it has been objected to by many of the leading apo- 
thecaries as an unnecessary measure and an irksome 
obligation. Senator Weismann, Chairman of the Com- 
mittee of Health, is understood to favor these modifica- 
tions, as being best calculated to simplify the opera- 
tions of the proposed board, and do away with the ob- 
jections urged against the passage of the bill. The 
pharmacists may rest assured that no effort will be 
wanting on his part to jealously guard their interest, 
despite the pressure brought to bear upon different 
members of the legislature by members of the present 
Commission. The saving for the coming year of seven- 
teen thousand dollars to the city should of itself be a 
conclusive argument in favor of the repeal of the pres- 
ent law, irrespective of the principle of placing a 



18 



THE MEDICAL RECORD. 



premium upon lopitimale education, wliicli is one of the 
main and truly commendable features of tlie proposed 
new law. We sympathize with the pharmacists in 
their struggle for their rights, and sincerely hope that 
they may triumph over all opposition. 



TUK QIKSTION OF QCARANTINE. 

The question of Quarantine has of late commanded 
more than ordinary attention. The medical profession 
have had the matter under serious discussion, and some 
valuable papers bearing upon the contagiousness of yel- 
low-fever, cholera, typhus fever, and variola have been 
read before the New York Academy of Medicine, with 
the result of placing upon record many important and 
interesting facts. The paper by Dr. Theodore "Walser, 
in the present number of the Record, is a contribution 
to the subject of more than ordinary value at this time, 
detailing, as it does, the experience of one who has so 
long and so conscientiously served the Quarantine De- 
partment. "We take occasion to commend his sugges- 
tions to the serious attention of our legislator?, who 
have it in their power to modify the laws governing 
that department. 



A MODEL HOSPITAL REPORT. 

The Report of the Imperial Rudolph Hospital, of Vi- 
enna, for the year 1870, which we have just received, 
is truly a model of its sort, and we take this occasion to 
commend it to the attention of the large number of 
gentlemen who appear to think that the possession of 
hospital appointments for Ufe, to the exclusion of oth- 
ers, entails upon them no responsibility towards the less 
fortunate members of the profession. In this report 
the usual tables of statistics are supplemented by a 
careful working up of each class of disease treated in 
the institution during the year, and by reports of all 
cases which hive any features of interest. Throughout 
the volume there is an entire lack of that self-glorifica- 
tion which eliaracterizes some of the so-called "hospi- 
tal reports " -which have appeared in our own large cit- 
ies, and which, instead of being what the term would 
indicate — a report of all the work done in the institu- 
tions during the time specified — are little more than a 
collection of monographs upon difi'erent subjects, by 
•several gentlemen, some of whom may never have had 
any connection with the institutions whatever. 



FORCED MEDICAL SERVICES. 

Toe /n^encfawf of Valparaiso, by a decree of date Octo- 
ber 11th, requires all the doctors of the city to submit 
to a weekly " turn,"' when they are to hold themselves 
in readiness to serve the pubhc, whenever called on, 
from 12 P.M. to 7 a.m., for an entire week, and this 
without any remuneration whatever, in case of the 
applicants being unable to pay them. They are also 
required to take turns in attendance at a public dispen- 
sary, also without remuneration. Two of the sixteen 



doctors of the city suspended all work for several 
days, but resumed practice again, witli the understand- 
ing that the " turn " should not be enforced, and the 
authorities are endeavoring to get physicians from 
abroad to remove to Valparaiso, on a contract to give 
their professional services for a term of years, under 
such laws, decrees, and ordinances as regulate the 
exercise of the medical profession in that country, and 
are to receive free pa.=sage to Valparaiso, and two 
hundred dollars per month, for the first three months. 
Before being permitted to practice they will (the cor- 
respondent of the Medical Times and (j'azette writes) 
be required to pass a medical examination in Spanish. 

On its face this is a very unjust and arbitrary law, 
and it is not to be wondered at that the profession as a 
body rebel. But aside from this, there are some modi- 
fying circumstances to be taken into account, which do 
not ordinarily obtain in medical communities. In the 
first place, the practice of medicine seems to be monopo- 
lized by sixteen gentlemen, the provisions of the law 
regulating said practice being sufficiently stringent to 
prevent the ingress of any ambitious outsiders. The 
queition is certainly a suggestive one, whether these 
gentlemen should not be willing, in lieu of such a 
monopoly, to give some of their services gratuitously to 
the State. The law supports their interests on the one 
hand, and it would appear to be nothing more than a 
just return for them, even at the risk of personal in- 
convenience, to conform with a law which has the 
ostensible object of protecting the commonwealth. 
Again, it would seem to be a reflection upon the pro- 
fession of that place that any law should be deemed 
necessary to compel their members to attend the poor ; 
but we are disposed to take a charitable view of the 
case by assuming that a law based on such grounds is 
really uncalled for. In spite of all this, it would seem 
that our brethren of Valparaiso are not so alive to their 
purely professional interest as their protest would lead 
us to expect, else the obnoxious decree would not com- 
pel them to assemble at least twice in each year for the 
purpose of discussing matters of medical interest to 
themselves and to the State. 



THE HEALTH OFFICER OF OCR PORT. 

The power of the Health Officer of this Port to quaran- 
tine vessels at his discretion has been very much 
abused, and besides opening wide the door for bribery 
in every conceivable shape, it has been conducive to 
much shameful oppression to our merchants. This, it 
seems, from facts brought to light by the recent inves- 
tigations of the Quarantine Sub-Committee of the Le- 
gislature, is particularly the case with the present 
incumbent. The system of hghterage, as now enforced 
under his direct patronage, is an abomination, and calls 
loudly for a remedy. The practice of fumigation, as 
carried on by him, is also deserving of the serious atten- 
tion of such as have it now in their power of remedying 
the impositions connected with it. At present vessels 



THE MEDICAL RECOKD. 



19 



are kept unnecessarily long in quarantine, and fumiga- 
tion is practised when there is no otlier apparent reason 
for the same tlian the mere object of increasing the 
emoluments of the officer by exorbitant charges. 
When we add to this the fact as brought out in 
the investigations of the Sub-Committee of the Lcgisla- 
lature, that vessels held in quarantine are not uniVe- 
quently released on the payment of a sum of money, 
eveiy unprejudiced person has a right to suspect that 
there is very good reason for the almost universal out- 
cry among the merchants, of corruption and fraud. 

In view of these charges, the profession owe it to 
themselves to enter their solemn protest against the 
course of the Health Officer of this port, and deny to 
him the right to represent them as a faithful protector 
of the health of the people on the one hand, and the 
rights of the commercial community on the other. 
Although, in a political sense, appointed as a representa- 
tive medical gentleman, he long ago forfeited his right 
to be so considered. His appointment to the responsi- 
ble office was viewed by the respectable portion of the 
profession of this city as an insult to their dignity. 
The recent developments of corruption in his depart- 
ment have in no way tended to alter professional opinion 
concerning him ; and we speak the sentiments of our 
medical brethren, when we say that his removal will 
be one of the first of the important steps taken towards 
remedying many of the existing abuses of the quaran- 
tine. The profession as a body have a right to a voice 
in this matter, and now seems to be the time when 
its wishes should be heeded by the Executive. 
{Since writing the above, and on the eve of going to press, 
tue learn that Dr. S. Oakley Vanderpoel, of Albany, 
has been nominated by the Governor, and confirmed by 
the Senate, to take the place of Dr. Carnochan. The 
profession have reason to congratulate themselves on the 
change, and to express themselves as perfectly satisfied 
luith the choice. Dr. Vanderpoel has held many offices 
of trust, and to this, the most important of all, he ivill bring 
a i-epntation for professional ability, and an unques- 
tioned integrity of character.) 



vol. VII. to end with the year. 
It has been deemed advisable by the Editor and 
Publishers of the Record to end the present volume 
with the year. In order to do this to the best 
of advantage to our readers, we have concluded to is- 
sue four double numbers during the year. We give 
the first of these with the present issue. 

EetJtntJs antr notices of HJoolis. 



A CLmiCAL Manual op the Diseases of the Ear. 
By Lawrence Turnbull, M.D. 

The general practitioner stands very much in need of 
all the information he can obtain upon diseases of the 
ear, provided it be real information, founded on the 
actual experience of some accurate observer. A book. 



professing to treat of diseases of the ear. should do so 
in detail, and should not be a mere compilation of what 
has been written upon the subject by other authors, 
and this is all that the work under consideration is, 
though it (.laiiiis to be more. Dr. Tuinbull is mistaken 
in thinking that the day has passed fir medical men to 
allirm that they " know but httle of the anatomy and 
physiology of the ear, and nothing about its diseases." 
Most of the general practitioners are lamentably igno- 
rant of the subject; and if they do not all confess their 
ignorance, do what is worse by concealing it, and do 
their patients a great deal of harm. The " scientific 
reformation " mentioned by Dr. Turnbull has not, un- 
fortunately, extended as far into tlie rank;: of the gen- 
eral profession as he imagines. The author's manner 
of expressing himself is generally obscure, and some- 
times almost incomprehensible ; e. </., in speaking of the 
mode of introduction of the Eustachian catheter, he 
mentions " two new forms with drawings from nature, 
the results of experiments on the cadaver and living 
subject." Now whether the ^' forms " refer to the 
catheter or to the shape of the mouth of t':e Eustachian 
tube it is difficult to say. There is but little original 
matter in the book, and this of but slight account. 
The author quotes constantly and profusely, but does 
not always give his authority, or where the original 
can be found. He introduces entire pages from the 
works of other authors, but does not give the title of 
the book or journal. The plates in the front of the 
book are lithographs from wax preparations, and can- 
not compare in truthfulness and value with Riidinger's 
photographs I'rom the cadaver. Wax preparations, no 
matter how carefully prepared, give a faulty conception 
of fine organs like the ear. The author has a way, in 
his anatomical descriptions, of introducing a sentence 
with a partial quotation, and finishing it with some re- 
marks of his own, instead of giving the quotation in its 
entirety, which seems to us decidedly unjust to the 
writer quoted. He makes tlie connection too close 
between catarrhal otitis media and disease of the bony 
structure of the ear. He errs in stating that the most 
fiequent cause of disease of the mastoid cells in child- 
hood is cold, contracted after birth, and followed by 
discharge ; for in almost all cases not dependent upon 
the eruptive fevers the cause should be sought in the 
strumous or syphilitic diathesis. In the chapter on 
otitis media and interna, Case I. is reported as " otitis 
interna of author, followed by death." Now this is 
certainly ambiguous, and likely to lead one to suspect 
a ghostly authorship for the book. 

In the chapter on chronic aural catarrh there are 
eleven pages quoted entire from G-ruber's book on Dis- 
eases of the Ear, which can scarcely be accounted for 
except as a means of filling up the chapter. 

The author devotes quite a long chapter to afiec- 
tions of the ear dependent upon disorders of the 
brain and nervous system, but as he tells us nothing, 
and makes several misstatements, the value of the 
chapter is rather questionable. One good point about 
the book is the frequent mention and high praise ac- 
corded to Dr. Roosa, for all that he has done to ad- 
vance the science of Otology. Dr. Turnbull has evi- 
dently read a great deal, and is tolerably well acquaint- 
ed with the subject, but his work as a compilation is 
of much more value than as an original treatise. 



Transactions of the American Ophthalmological 
Society. 

Tnis organization is composed of fifty-one active, and 
seven honorary members, representing the majority of 
the leading ophthalmologists of this country. The 



20 



THE MEDICAL RECORD. 



oiphtli unnnnl meetino: was hold at Newport, Rliode 
Islaiul, July 20th and 21st, 1871. The subjoined inter- 
esting and scientific papers were presented : Report on 
iho progress of Oplillialinology, by B. Joy .lefVi ies, M.I)., 
lios'ton, occupying filtv-nine of tlie 149 pages ; An Ap- 
paratus for Cutting Microscopic Sections of Eyes, by 
Kdward Curtis, M.D., New York: General Syphilitic 
liillaMinintion of the Eye, by Franci.s DelafieKi, M.D.. 
New York; Halo round the Macula Lutca, by I']dwara 
Ct. Loring, M.I)., New York; A Scheme to Aid in Ex- 
amining and Il"coriiing Cases of Functional Trouble of 
the Eye, by Henry D. Noye?, M.D., New York; On 
the Tables Given by Loring and Knapp to Show the 
l)i*pl:icement of the Retina in Eminetropia, by O. F. 
WaJswoitli, M.D., Boston; Variety of Forms of Small 
Tencils of Astigmatic Ray.s, by G. Hay, M.D., Boston; 
The Retina an Asymmetrical Surface by Russell Mur- 
doch, MIX, Baltimore, Md. ; An Additional Method 
for the Determination of Astigmatism, by Geo. Straw- 
bridge, M.D., Philadelphia; On Astigmatism as an Ac- 
tive Cause of Myopia, by John Green, M.D., St. Louis, 
Mo. ; Remarks on Cataract, by Edward G. Loring 
.^LD., New York ; An Apparatus for Testing the Per- 
foplion of Color, by Henry D. Noyes, M.D., New 
York; Description of a Jaeger Ophthalmoscope, as 
modified by George Strawbridge, ^I.D., Philadelphia; 
(runshot "Wound of the Brain, Ibllowed by Fungus 
Cerebri, and Recovery with Hemiopsia, by "W. W. 
Keen, M.D., and William Thomson, M.D. ; Detachment, 
of the Retina, ■with Laceraiion at the Macula Lutea, by 
Henry D. Noyes, M.D., New York; Report of Passa- 
vant Operations with and without Ether, and also 
under Nitrous Oxide, by B. Joy JefTries, M.D. ; Case 
of Readjustment of the Levator Muscle of the Upper 
Lid, by John Green, M.D., St. Louis, Mo.; Additional 
Note upon the Use of Atropia in the Treatment of In- 
cipient Stabismus, by the same author; Paralysis of 
the Trigeminus, followed by Sloughing of the Cornea, 
by Wm. F. Norris, M.D., Philadelphia; A Case of 
Congenital Fissure of the Lids, by W. W. Scely, M.D., 
Cincinnati ; C mgenital Absence of both Eyeballs— .- 
Two cases, Reported by Geo. Strawbridge, M.D., 
Philadelphia. 

The following gentlemen v.-ere re-elected as Oflicers 
for the ensuing year: President. Dr. H. W. Williams, 
of Boston; Vice-President, Dr. C. R. Agnew, of New 
York ; Recording Secretarjj and Treasurer, Dr. Henry 
D. Noye?, of New York ; Corresponding Secretari/, Dr. 
H. Althof, of New York ; Committee on Progress of 
Ophthalmologi/, Dr. B. Joy Jeffries, of Boston ; Pub- 
lishing Committee, Drs. Loring, Roosa, and Noyes. 

On the Use op the OriiTnAi.MoscopE ix Dlseases 
OF the Neuyous System and op the Kidneys. 
By Thomas Cliffoud Allbutt, MA. , M.D., Cantab. 

It is with great pleasure that we call the attention of 
our medical brethren, general practitioners, as well as 
specialists, to this valuable contribution of Dr. Allbutt. 
It aids very materially in filling up a long-existing 
vacuum in ophthalmic medicine; for although many of 
the subjects contained in it have already been di,?cussed 
in scattered articles in the periodicals, most of them 
have been in a foreign language, and this is the first 
attempt that has been made to collect in a single volume 
the views of distinguished writers. The value of the 
work is very nmch enhanced by the careful investiga- 
tions of Dr. Allbutt himself who has brought to the 
work an amount of painstaking labor, caution, and fair- 
ness of discussion truly admirable. The diseases treat- 
ed of in the separate chapters are all represented Ijy a 
large number of cases contained in the appendix, and 



in reviewing the work we shall discuss each chapter by 
itself. 

In .speaking of the anatomy of the optic nerve and 
retina, the author gives a very correct idea of the caluseB 
of optic nerve-trouble, viz. : that it is " due to its own 
structure and attachments, to its rich va.scularity, its 
large share of connective tissue, and its cxlei»sive rela- 
tions with part? at the base of the encephalon ; and not 
in any way to its especial altitude as a sensi', not even 
in such disease ■! as locomotor ataxy." He emphasizes 
very properly the necessity and importance of examin- 
ing the field of vision in all cases where the optic nerve 
is affected. He calls special attention to the great vas- 
cularity of the optic nerve, indirectly connected with 
the cerebral vasimlarity, and to a great degree inde- 
pendent of the retinal circulation ; but omits mention 
of the intimate anastomosis between the retinal and 
nerve-ves-sels, whi:;h is a very important point. The 
anatomy of the optic nerve and its intimate connection 
with the brain is very carefully and accurately given, 
and this latter point cannot be to highly valued nor too 
of! en brought to our mind. Dr. Allbutt very justly 
calls attention to the small radiating vessels of the di.sk, 
and their increase in size and number in congestion 
and inflammation. He discredits the statement that 
the .sympathetic nerve exerts any influence in produc- 
ing a change in the di.<k and retina. One of the most 
importnnt points in this cliapter is the distinction which 
the author draws between anosmia and atrophy of the 
disk, and between partial and complete anajmia, and 
a'so that between ischa?mia papilla; and optic neuritis. 
Ischajmia papilla; is confined to the disk, and is a con- 
gestion of the vessels; it occurs much more commonly 
than neuritis, and in it the nerve-tubes undergo little or 
no injur}'. In true neuritis, on the contrary, the con- 
nective elements sufl'er first, then the nerve-fibres, and 
the subsequent congestion is slight. It affects the 
nerve-trunk, and hence is called " neuritis a.scendens." 
Dr. Allbutt thinks that the " consecutive atrophy " of 
Hughlings Jackson, distinguished by the ragged edges 
and blurred outline of the disk, is not distinct from the 
simple or progressive atrophy, distinguished by its 
clean-cut outline and brilliant appearance, but is merely 
an earlier stage of it, before the exudations have been 
absorbed. 

The article on primary atrophy of the optic nerve is 
very complete, and proves the author to be possessed 
of nice powers of observation. He gives four causes 
for this form of atrophy, viz. : 1st. Any tumor or patch 
of inflammation in the course of the nerve behind the 
eye, which severs the nerve-fibres and leaves the se- 
parated parts to wither. 2d. Destruction of the centres 
of vision making the nerve useless. 3d. A sclerotic 
process associated with patches of sclerosis elsewhere, 
as in the spinal cord or encephalon. 4th. Deficiency 
of nutrition, as is seen in senile degeneration of the 
arteries and in embolism. 

The cliapter on the relation between certain intracra- 
nial disorders and affections of the optic nerve and 
retina is the most voluminous, and perhaps the most 
important in the book. It is very carefully written, 
and presents a mass of very interesting statements 
illustrated by cases in the appendix. Many of the 
statements are recognized as facts by ophthalmologists 
generallj', but some of them cannot be considered as 
satisfactorily proven until fortified by a larger number 
of cases. We agree most cordially with Dr. Allbutt, 
however, when he saj's, " the occurrence of papillary 
ischfemia or optic neuritis in any person ought to awak- 
en the gravest suspicions of cerebral disorder, and the 
occurrence of simple atrophy should suggest great 
watchfulness." 



THE MEDICAL RECORD. 



21 



Tn speaking of tlie influence of epilepsy upon the 
appearance of the disk, Dr. AUbutt thinks that cerebral 
venous congestion may have the same effect upon the 
disk as cerebral anii^mia, but that an ophthalmoscopic 
examination should always be made in the intervals of 
the attacks as well as during tlie convulsion. He also 
thinks that the anivmiaof the disk, as well as the con- 
gestion, may persist for hours, and even days, after the 
attack. In tubercular meningitis, the author thinks 
that the exudation at the base of the brain may press 
upon the cavernous sinns, or the inflammation may 
involve it, in which case we have ischemia papiUce; or 
the inflammation may creep down the nerve and cause 
neuritis, both of which states may be, and generally are, 
followed by atrophy. We think Dr. AUbutt attributes 
too much importance to the appearances of the disk in 
cases of children suffering from symptoms of meningitis, 
for the congestion of the disk may be caused by the 
simple straining in the vomiting, and is by no means 
necessarily connected directly with brain trouble. 
Still the author is very cautious and fair in all his state- 
ments, and very correctly asserts that tubercular menin- 
gitis is only revealed to the ophthalmoscope when it 
invades the anterior and inferior parts of the encepha- 
lon near the optic tracts. 

In hydrocephalus Dr. AUbutt says that ischremia 
papillfc is the earliest change ; but subsequently the 
disks and retina} become wholly disorganized, and the 
optic nerves atrophy from pressure or from abolition of 
their function. The changes are mainly due to pressure 
or severance of central connections, though, perhaps, 
some inflammatory action and proliferation may also be 
present. 

The section upon intracranial tumors constitutes al- 
most a monograph in itself, and exemplifies perfectly 
the caution and strictness with which the author selects 
his own cases, and sifts the evidence of authors. He 
admits that we cannot say when to expect eye-symp- 
toms in the course of intracranial tumors ; what conclu- 
sions to draw from them when present, or how to ex- 
plain their occurrence in many cases ; but insists that 
by the use of the ophthalmoscope we do gain very 
important information. We have here to answer two 
questions, viz. : Is there an encephalic tumor present? 
and if so, what is its size and situation ? It being con- 
ceded that changes in the optic nerve are a frequent 
accompaniment of tumors, we must inquire what are 
the conditions of this coexistence. The author gives in 
full Benedikt's hypothesis of the cause of the ophthal- 
moscopic appearances, and then very carefully shows 
what he considers to be its fallacies. In answer to 
Benedikt's first point, that trophic disturbances are due 
to disturbances of the circulation set up by direct or 
indirect pressure, he admits that pressure will set up 
these changes, but asserts that the agent in many cases 
is not mere local pressure, but a general elevation of 
intracranial tension due to excess of contents. He 
admits Benedikt's second point, that a neuro-retinitis 
caused by a tumor can be entirely reduced without any 
diminution in the size of the tumor; but says it is not 
common, and asserts that the growth of a tumor is at- 
tended with destructive effects which might soon com- 
pensate the encroachment of the tumor itself Bene- 
dikt's third point, that it is difficult to see why the 
congestive phenomena should set up mechanical hin- 
drance in no other circulation, and should cause pressure 
upon no other nerve-district than that of the eye only, 
jie explains away by the fact that a rapidly growing 
tumor would compress the surrounding tissues and 
greatly increase tension, W'hich would become specially 
manifest in the disks on account of the multipl5nng 
action of the scleral ring. In answer to Benedikt's 



fourth point, that a neuritis dcscendens can only be 
admitted if the amblyopia sets in without ophthalmo- 
scopic appearances, and the changes in the dis-ks show 
themselves gradually ; he again insists upon the neces- 
sity of distinguishing between ischtcmia papilke, where 
the disk alone is affected, and that condition in which 
the whole length of the optic nerve is in a state of 
active hypenttmia with cell-proliferation. We should 
always remember that neuritis is not so much a disease 
of the nerve as of nerve-investment. Dr. AUbutt in- 
sists very properly that neuritis, properly so-called, 
does not coexist with non-inflammatory intracranial 
disease, but that the latter rather gives rise to ischic- 
mia, while, on the other hand, primary neuro-retinitis 
accompanies inflammatory disease. The passive hyper- 
aMiiia, helped by the action of the scleral ring, produces 
the choked disk, while the phenomena of neuritis point 
to a biological process of cell-proliferation due to in- 
flammation, that is, to meningitis, or, in rare cases, to 
encephalitis. The atrophy of the optic nerve, found in 
connection with intracranial tumor, Dr. AUbutt holds 
to be due to the crushing or dividing action of tumors 
of the base, or from the pressure of hydrocephalus upon 
the optic tracts or centres. The division of the intracra- 
nial cavity into seventeen regions, in order that we may 
know what symptoms follow the growth of a tum.or in 
any of them, we do not think is justified by experience, 
and hence is to be regarded as unnecessarily complicat- 
ing. In referring to tumors of the tubercula quadrige- 
mina. Dr. AUbutt does not go so far as to assert that ob- 
literation of thequadrigeminal bodies must cause blind- 
ness; but he does think that injury of these bodies 
causes amaurosis, which also accompanies the destruc- 
tion of parts lying near them, and that here loss of 
vision preceded a progressive atrophy of the optic 
nerves. One assertion of the author will be admitted 
by all ophthalmologists, viz. : that the nearer the tumor 
approaches to the anterior and middle fossai of the 
skull, the more frequently does amaurosis occur, and in 
a tumor of the middle fossai the optic nerves seldom 
escape. In cases of persons struck down by apoplexy, 
the author has frequently found a deeree of nerve atro- 
phy, attended with some degree of loss of vision, and 
thinks it due to atheroma of the encephalic arteries, and 
may be recognized in some degree as a forerunner of 
apoplexy. This, however, needs confirmation. 

Dr. AUbutt calls particular attention to the ten- 
dency of the optic nerve to atrophy in almost all cases 
of general paralysis. The change is sometimes simple 
white atrophy of the optic nerves, more commonly 
preceded by redness, and not infrequently results in 
complete amaurosis. The pathological characters are : 
dwindling of the proper nerve-structure, and over- 
growth of the connective tissue. The author gives 
several explanations for the change, viz. : 1st. If lu- 
minous impressions are perceived in the cortical mat- 
ter, it might be expected that as the perceptive centres 
wasted in disease, the optic nerves would waste from 
disuse. 2d. The degeneration of the optic nerves may 
be due to atheroma of the vessels. 3d. The most pro- 
bable explanation is to be sought in the peculiarity of 
the primary morbid change and in the anatomical char- 
acter of the tissues which it invades. It seems safe to 
say that the optic nerves are more liable to sclerosis 
than other nerves, which we should expect from their 
vascularity and richness in connective tissue. 

The ophthalmoscopic signs of disturbance of the 
optic nerve and retina in diseases of the spine are 
divided by Dr. AUbutt into two kinds: 1st. Simple or 
primary atrophy of the nerve, sometimes accoiupanied 
by slight hyperaimia and active proliferation, which 
make up chronic neuritis ; and, 2d. A characteristic 



oo 



THE MEDICAL RECORD. 



liyponcniic change, occurring only in cases of injury to 
the si»iiie, in whieli tlio arteries becnnic inihstinj^uish- 
abK», wliih' llic veins are swollen and tortuous, and the 
disk assumes tlie appearance of isi-hiuniia. In trying 
to explain how these changes are cau.ved, Dr. All- 
butt objects to Wharton Jones's view, that in injury 
of the spine the sympathetic nerve is involved, and as 
this governs the blood-vessels, and the latter the nutri- 
tion, therefore the changes are due to irritation of the 
sympathetic; but he admits that he is not able to pro- 
pound any more satislaotory theory. He thinks atro- 
phy of the disks is always ihn? lo slow degeneration of 
the cord, while tlie ciioked disk and neuritis arc not 
peculiar to spinal disease, but are met with in ence- 
phalic disorders ; and the neuritis is seen in injury of the 
cord, particularly in sclerosis of the posterior columns. 

In disorders of vision associated with all)uniinuria, 
Pr. Alll)Utt distinguislies two kinds, viz. : 1st. Attacks 
of partial or absolute blindness, coinciding with the 
uraMnic poisoning state; 2d. Impairments of vision, 
which advance more gradually, last longer, and are 
dependent upon visil>lo chaiiges. The first, called 
nrieiiiic amaurosis, may exist alone, or may precede or 
complicate the second or retinitic amaurosis. It may 
precede any symptoms of renal disorder, and cannot be 
demonstrated by the oplithalmo?cope. The changes of 
the second form are in the retina, are partly I'atty, 
partly a sclerosed action, and involve the nerve-tissue 
as well as the connective-tissue framework of the retina 
and the adventitia of the vessels. 

Speaking of leuctemic retinitis, the author thinks that 
the hypothesis of adenoid tumors in the retina of leucfe- 
mia must be abandoned, as not based upon sufficient evi- 
dence, and that we must fiill back upon the belief that 
leucivmic. like albuminuric retinitis, is a combination 
of hemorrhagic with irritative events; but that in both 
diseases we are as yet in want of further evidence as to 
the mode and causation of the latter. As regards the 
form of retinitis associated witii syphilis, the author is 
strongly inclined to coincide with Mr. Oglesby in at- 
tributing to it peculiar destructive appearances. We 
do not agree with him on this point, but think the 
retinitis to be similar in appearance to other forms 
of simple retinal inflammation, and that a diagnosis of 
a specific cause can only be made from coincident 
general symptoms, though we are aware that many 
good observers, particularly among our German con- 
temporaries, agree with Mr. Oglesby. 

The chapter on toxic amaurosis is very interesting. 
Speaking of alcohol poi^oninir, tlie author very justly 
says: "As in ur&imia, so in this, there is an amblyopia 
potatorum with ophthalmoscopic sign^ and an ambly- 
opia without them. Tlie latter defect is not rare, and 
may be due to congestion of the choroid, with conse- 
quent pressure upon the layer of rods and cones of the 
retina. The other kind of amblyopia seems to depend 
on this same congestion, witli consequent tissue-degen- 
eration of the optic nerve. Dr. AUbutt passes over the 
subject of tobacco-amaurosis very lightly, regarding it 
as not yet satisfactorily proven. In lead poisoning 
he thinks that the atrophy of the optic nerve some- 
times met with is occasionally preceded by a stage of 
subacute irritation. 

In the article on hypnosis and narcosis. Dr. Allbutt 
speaks of two kinds of sleep, viz. : Sleep, artificial or 
natural, due to anaemia; and sleep, artificial or natural, 
due to venous congestion of the capillaries; and he 
thinks it probable that narcotics produce their effect j 
by venous hyperaemia of the brain. 

In conclusion, we wouLl most cordially recommend 
Dr. Allbutt's book to the perusal of every practitioner, 
as a very valuable contribution to medical science. | 



TiiK PiivsiriAN'H Daily PorKicT RKfonn : Comprising 
a Visiting List, etc. By S. W. IJi ti.kh, M.D. Phila- 
delphia, 1(S71. 

Tme objectionabl(! feature of this book is the amount 
of printed matter which it contains. A memorandum 
with its pocket full of cards, prescription blanks, etc., is 
at best an awkward burden to have always in one's 
coat-pocket, and is a sullicient reason for leaving out 
such matter as tables and directions for urinary analysis 
— which can only be undertaken in a physician's office 
— and lists of remedies and doses other than such as re- 
quire .special care in their use. If a list of new reme- 
dies is added, it should only include such as are yet on 
trial, and regarding whose merits the majority of phy- 
sicians are imdecided. Such a list, with doses and the- 
rapeutical indications as far as known, might aid in ad- 
vancing greatly our knowledge of such remedies ; but 
we can hardly think it necessary to put into such a 
category the bromide of potassium, as regards iLs influ- 
ence in epilepsy, pumpkin seed as an anthelmintic, 
ipecacuanha for dysentery, M ousel's salt as a styptic, 
or carbolic acid as a disinfectant. Whereas, we would 
expect to see something said about chloralum and ni- 
trite of amyl, which we do not in the present instance. 
That])ortion of the book devoted to the visitinglist, re- 
cord of obstetrical cases, vaccinations, deaths, etc., is 
very commendable, the visiting list especially so, as it 
can be used for any year, from any date, and for any 
number of patients, without waste of room. The use 
of springs in the cover to keep the book closed, thus 
doing away with the need of an elastic band or tuck, 
is a very great convenience. 

PuT.MONARY CoNSUMPTiox ; its Nature, Varieties, and 
Treatment, with an Analysis of One Thousand Cases to 
exempHfyits Duration. By C. J. B. Williams, M.D., 
and Charles Theodore Williams, M.D. Philadel- 
phia: Henry C. Lea, 1873. 8vo, pp. 315. 

This volume, containing as it does a summary view of 
the opinions of a gentleman whose "experience in dis- 
eases of the chest in private practice during the last 
forty years has probably not lieen exceeded by that of 
any other physician," complemented by statistics of 1,000 
cases selected from his note-books during a period of 
twenty-tAvo years, its practical value to the medical 
practitioner is very great, independently of any appro- 
val or disapproval of the author's theory of consump- 
tion. This tlieory, which tlie senior author has ad- 
vanced for more than forty years, and which receives 
support from modern pathological research, is, " that the 
tuberculous and kindred lesions whicli cause consump- 
tion of the lungs, arise from a degradation of the plas- 
ma or nutritive material by which old textures are re- 
newed and new ones formed." "This material, or pro- 
toplasm, is seen in an inflamed part of a living animal 
in the form oi sarcophytes or bioplasts^ multiplying and 
clinging to the insides of the blood-vessels, penetrating 
their walls, and emigrating by a movement of their 
own into the adjoining tissues. Like other forms of 
animal and vegetable protoplasm, these sarcophytes 
have vital endowments of motion, growth, power of ab- 
sorbing and digesting various matters from without, 
and of multiplying by division, and probably also by 
gemmation and endogenous proliferation." 

These sarcophytes or pale corpuscles exist naturally 
in very small numbers in the blood, but in greater 
abundance in the lymphatic system, and they may 
multiply and decay independently of inflammation, 
constituting a true scrofula; Avhen overcrowded and 
hardened from loss of their plastic and self-sustaining 
power, they become the gray tubercles, obstructing the 



THE MEDICAL RECORD. 



23 



adjoining tissues, and irritating them, and in them- 
selves prone to decay. 

The causes of consumption are classed as follows: — 

1. General causes, -vvliicli by their weakening in- 
fluence on the constitution generally predispose to con- 
sumption. Such are family predisposition, want of 
pure air and good food, continued fever, scarlatina, 
measles, cessation of discharges, miscarriages, bad con- 
finements ; and over-lactation, mental depression, damp- 
ness of habitation. 

2. Local causes, the effects of which are limited at 
first to the lungs, but may at a later date extend to the 
system. Tliese are: attacks of bronchitis, hooping- 
cough, and croup; attacks of pleurisy and pneumonia; 
attacks of asthma; trades and occupations giving rise 
to a dusty or gritt}^ atmosphere ; injuries. 

Tlie 1,000 cases selected for statistical purposes are 
taken from notes of about 25,600 cases, accumulated 
during some thirty years, representing all the cases 
of any gravity in which the author has been consulted 
in private practice. The average duration of the 1,000 
cases was nearly eight years. Tliey are divided into 
two groups; phthisis of inflammation, and phthisis of 
constitutional origin. The first group includes varieties 
designated as fibroid, suiDpurative, chronic pneumonic, 
scrofulous pneumonic, catarrhal, albuminous, hemor- 
rhagic, and others more or less mixed, and in their 
course assuming more or less of the form of constitutional 
phthisis. The second group includes acute tuberculosis, 
chronic tuberculosis, and scrofulous consumption. These 
are represented as varieties of one common disease, 
varieties not always distinct and easily passing into one 
another. 

With regard to the treatment of consumption, our 
author, on taking a retrospect of an experience of forty 
years, can trace a remarkable improvement in its suc- 
cess. This is due, in great measure, to the use of cod- 
liver oil, in connection with the liberal use of nutritious 
food, and the administration of tonics. The tonics on 
which most reliance is placed are quinine and iron, but 
they are not deemed useful as long as there exists any 
inflammation, active or intercurrent. Under these cir- 
cumstances ealumba, cascarilla, and chiretta are pre- 
ferred. The oil recommended is the pure pale oil. The 
best time for its administration is immediately after a 
solid meal, or at or before the meal, for those who pre- 
fer it so. It thus forms part of the chymous mass, less 
apt to rise by eructation, and less apt to disorder the 
stomach. It is given with an aromatic bitter, acidu- 
lated with a mineral acid, and, where a tonic is given, 
it is added to the dose of oil, the dose of which should 
rarely exceed a tablespoonful twice or thrice a day. 

With regard to climate, it is advisable that the 
patient should breathe as pure an air as possible, and that 
its beneficial influence should be increased by such 
gentle and varied exercise in it as his strength and the 
conditions of his organs will permit. 

The separate points of special forms of phthisis and 
their management are treated of fully and in sufficient 
detail. 

Consumption is such a fearful destroyer of human life, 
that every valuable communication concerning it de- 
mands the serious attention of the physician. He will 
find much to admire, and much to follow, in this useful 
summary of a well-known aud distinguished author. 

A Practical Treatise on Brigiit's Diseases op 
THE Kidneys. By T. Gr.\inger Stew.\rt, M.D., 
F.R S.E. Second edition. New York : William Wood 
& Co. 1871. 

We welcome this work as a model of what a second 
edition should be. The revision of the first edition, 



which appeared in 18G8, has been very thorough. The 
size of the volume has been nearly doubled, the addi- 
tions consisting mostly of reports of cases which are of 
great interest, and strongly enforce the views of the au- 
thor on certain disputed points in the pathology of 
Bright's Diseases. A supplementary chapter has been 
added on " The Complications of the Different Forms 
of Bright's Disease," and two new lithographs have 
been introduced. But, besides these improvements, 
the work bears evidence of careful attention to the 
minuter details of revision. Sentences are reconstruct- 
ed, positive statements qualified, new modes of treat- 
ment suggested ; in a word, the author gives us the re- 
sults of three years' additional study of these " well- 
known but little understood diseases." To review this 
book as its merits deserve would require more time 
and space than we can command, but it may be of in- 
terest to notice a few points in pathology in which the 
author differs from the views expressed by Dr. Dickin- 
son in his work on Albuminuria. Dickinson adopts the 
classification of Virchow, according to which the differ- 
ent forms of Bright's Disease are distinguished by the 
tissue primarily and principally affected. When the 
renal tubules are the principal seat of the morbid pro- 
cess, we find the large red or the large white kidney 
the result of an acute or of a chronic tubal nephritis; 
when the affection starts with and is chiefly confined 
to the intertubular matrix of the organ, we have the 
contracted, granular or cirrhotic kidney; thirdly, the 
amyloid or " depurative" disease, which primarily affects 
the walls of the smallest arteries, especially the convo- 
lutions composing the Malpighian tufts, but subsequent- 
ly extends, by exudation of the amyloid material, to 
the intertubular s{)aces, and may ultimately lead to di- 
minution in the size of the organ through contraction 
of the exudation. Stewart's classification is widely dif- 
ferent from this, but is, Ave are convinced, more in ac- 
cordance with recent pathological views. His division 
is as follows : — 

" 1st. The wflammatory fo7-m, of which there are 
three stages. 

a. That of inflammation. 

b. " " fatty transformation. 

c. " <' atrophy. 

2. The waxy or amyloid form, of which also there are 
three stages. 

a. That of degeneration of vessels. 

b. '■ " secoiidary changes in the tubes. 

c. " '• atrophy. 

3. The cirrhotic, contracting or goidy form ." 
According to the author, an atrophied kidney may 

belong to any of these three divisions; Dickinson 
would exclude it from his first division, tubal nephritis. 
Stewart thus expresses his views in regard to the rela- 
tion between tubular inflammation and atrophy of the 
kidney. " The first stage is that of inflammation, in 
which exudation is poured out, and a destruction of the 
epithelium takes place. This exudation, affecting a 
large number of tubules, leads to enlargement of the 
organ, and also to fatty degeneration of the epithelium ; 
its absorption or removal leads to ultimate atrophy." 
The granular or " uneven surface is due to the irregular 
affection of the tubules, some being involved and under- 
going atrophy while others escape, . . . and not to the 
contraction or outgrowth of connective tissue." 

Dickinson dissents emphatically from the view that 
a granulated contracted condition of the kidney may 
result from a tubal nephritis. " If," he says, " in sim- 
ple tubal nephritis, the loss of the contents of the tubes 
ever suffices to reduce the once enlarged kidney below 
the natural bulk, such a result must be of rare occur- 
rence, since no unequivocal instance has fallen under 



2i 



TilE MEDICAL RECORD. 



the observation of the author." Case No. XIX. in the 
present work bears directly upon this point. Wc have 
not the sjiace to quole it, but any one interested in 
renal i)ath'ilogy would be amply repaid by carefully 
studying,' Dr. Stewart's commentaries upon it. That 
thi.s furm of atropliy is not of fretpient occurrence is 
doubtle.-s duo to the f.ict lliat patients with this variety 
of Brighl's Disease j^encrally recover or die before this 
stage of degeneration is readied. The microi^cope will 
generally show, in a kidney thus contracted, a relative 
excess of connective tissue, but this degeneration may 
be distinguished from a true cirrhosis by noticing the 
considenvble amount of disease in the tubes not yet ob- 
literated, and the absence of the characteristic broad 
masses of connective tissue found near the surface of a 
cirrhotic kidney. 

Our autlior vigorously combats Dr. Dickinson's views 
as to the pathology of the amyloiil disease. He agrees 
with him that the amyloid material consists of an al- 
buminoid sub.-^tance probably delicient in alkah, but he 
denies tliat it has any necessary or constant relation to 
the suppurative process as indicated by Dickinson's 
unfortunate term " depurative disease." In 18 cases 
coming under the author's observation, only C> were 
found, after careful examination, to have suffered from 
a past suppuration. ]Ie maintains, moreover, that the 
disease is essentially a degeneration of tissue, and in no 
sense an infiltration by any ingredient of the blood. 
'"That it is not an infiltration." he says, "will become 
apparent if we consider the parts it affects. We have 
seen that it affects the cells of the liver. This might 
well be a result of infiltration, for we constantly see the 
same structures loaded with fat which has been poured 
out from the blood. But far more generally through- 
out the body it affects small arteries. How is this to 
be explained on the infiltration theory ? How can it 
happen that the small arteries — nay, the small arteries 
of certain organs— nay, the middle coat of the small ar- 
teries — should be the chosen seat of deposit of a ma- 
terial poured out from the blood ? If it be poured out 
from the blood, why does it so generally confine itself 
to the walls of arteries and unstriped muscular fibre ? 
Why does it not infiltrate the parenchyma of organs? 
Why does it, in the intestine, as it flows from the 
blood, confine itself to the walls of small vessels, to the 
muscles of Briicke, to the epithelium ? Why does it 
not pass out among the cellular tissue of the villi, and 
become deposited there ? These questions can scarcely 
be answered by those who hold the infiltration theory. 
On the other hand, how exactly the characters corre- 
spond to those of degeneration, — certain tissues always 
primarily aflfected, those tissues presenting every de- 
gree of alteration from the slightest to the most dis- 
tinct, the surrounding parts remaining unaffected. The 
closest analogy exisis between what is seen in this 
and in the atheromatous and calcareous degenerations, 
the former affecting the inner coat of arteries, and es- 
pecially the deeper layer.«, the latter, when primary, af- 
fecting the middle coat. Both are independent diseases 
originating in the tissues, not even secondary results 
of infiltration." 

By the cirrhotic kidney our author understands " an 
hypertrnphij of the connective tissue, and a consequent 
atrophy of all the other structures." He objects to the 
term granular kidney because the same condition is 
found in the third stage of the inflammatory and amy- 
lOid diseases; to the term gouty kidney because the dis- 
ease often occurs independently of gout ; to the term 
contracting kidney because contraction is not peculiar to 
this variety; and to " intertubular or interstitial nephri- 
tis" because there is no evidence of inflammation. He 
ho'ds to the non-inflammatory nature of the morbid 



process, and denies that there is any evidence that an 
inflammatory exudation takes place into the intertubu- 
lar spaces. Further investigations are needed in regard 
to the essential jihenomena of inflammation before this 
question can bo discussed in an entirely satisfactory 
manner. 

Wc congratulate the publishers on the creditable 
style in which the work is is.sued. The cloth binding 
has the American merit of being firm and substantial. 
Why is it that our English bretliren persist in so fast- 
ening their cloth bindings that they fall to pieces after 
the book has been used half a dozen titucs? The 
paper, letter-press, and lithographs, plain and colored, 
are excellent, and we lieartily rejoice that the time has 
come when a physician can gratify his taste for hand- 
some books in his medical as well as in his literary li- 
brary. 

The Science and Practice op Suugery. Illu.strated 
by four hundred and seventy wood engravings. By 
Fkedeiuck James Gant, F.R.C.8., Surgeon to the 
Royal Free Ho.spital ; formerly Surgeon to Her Majes- 
ty's Jlilitary Hospitals, Crimea and Scutari. Philadel- 
phia : Lindsay ic IJlakiston. 1871. 

In the preface of this work, wc are told that now many 
years have elapsed since a new systematic work repre- 
senting the science and practice of surgery has ap- 
peared in his country, and that it is the aim of the 
writer to give a full but condensed embodiment of all 
those changes in the pathology and treatment of inju- 
I ries and diseases which the progress of surgery has 
established. Evidently the intention of Mr. Gant has 
been to make a big book, and certainly in appearance 
it is very pretentious, to say the least. By gleaning 
largely from the writings of English surgeons, and per- 
haps chiefly from the articles contained in Holmes' 
System of Surgery, the book has grown to one of con- 
siderable size. Indeed, we nmst look upon it pretty much 
in the light of an epitome of the more recent English 
authors, and as such it must be regarded as a work of 
no little value. In a book of this kind, however, we 
think its value would have been greatly enhanced, if 
the writings of Continental as well as American authors 
had been a little more consulted. Had this been the 
case, in our judgment both the pathology and the 
treatment advocated in many affections would have 
been more in keeping with the progress of science 
than we find to be the case in many parts of this work. 
Full and due credit has been given to all the sources 
whence information lins been derived, and through- 
out the work the author's own surgical experience 
and pathological observations have been freely inter- 
spersed. 

The subject of inflammation is considered entirely in 
accordance with the views which have been adopted 
by most English writers, and differs but little, if at all, 
from what was taught many years ago. We were no 
little surprised that in this field the labors of the Ger- 
man pathologists were hardly noticed. No reference is 
even made to the researches in this direction by 
Strieker, Recklinghausen, or Cohnheim. Should our 
author even dissent from these views, he should, at 
least, have acquainted the reader with the more 
modern views on this important subject. 

Tumors we find classified into those that arc localized 
(not infiltrating), which includes some of the recurring 
varieties, and into the infiltrating growths, as the varie- 
ties of cancer. The whole subject of these grov/ths 
is but briefly referred to, with the exception of that 
of cancer, which is more fully and much more satisfac- 
torily treated. While reading the chapter on tumors, 
it is with difficulty that one can persuade himself that 



THE MEDICAL RECORD. 



25 



he is not turning over the pages of Mr. Paget or Mr. 
Moore's excellent treatises on this subject, as found in 
Holmes' Suigery. 

Were we to criticise the cbapter on syphilis as we 
believe it deserve?, we should tuke up more space than 
can be allotted for a notice of the whole work. Did 
we desire to thoronghly confuse a student on the sub- 
ject of syphilis, we could not succeed better than ask 
him to read this chapter. Mr. Gant states his views 
incline to the opinion '• that while the indurated chan- 
cre possesses the greater power of producing constitu- 
tional syphilis, and is thence the most freciuent cause; 
yet that so/if chancres may also occasionally have this 
causative relation. Hence, they also may be regarded 
as forms of primary syphilis." We were no little sur- 
prised to fmd the statement here made that a chancre 
on the glans penis never acquires induration. Suffice 
it to say, that this article savors more as if it came from 
the pen of one whose information had been derived 
from reading, rather than from actual experience in the 
study of this disease. 

While speaking upon the subject of the treatment of 
erysipelas, especially in those cases where the skin is 
tinged with a yellow hue, even when " verging on 
jaundice," we must dissent from the view here ex- 
pressed that this condition is best overcome by the re- 
peated (italics our own) administration of calomel or 
blue pill, to restore the secretion of bile. Cases present- 
ing these symptoms which have passed under our ob- 
servation Avould have exhibited a very unpleasant result 
from such treatment. 

Pycemia is treated not in accordance with the more 
recent views that pathologists have advanced, and the 
same is to be said in reference to phlebitis. When 
describing the symptoms of pyaemia, no mention is 
made as to the rapid rise of temperature, as indicated 
by the thermometer just before and during the period 
of chills, (fee. ; nor are the diseases which the student 
might mistake it for mentioned, nor is he told the usual 
duration of the disease. 

The chapter on gunshot wounds is very meagre, and 
certainly not such as we would have expected to have 
emanated from one who has been a military surgeon. 
Had some reference been made to the experience 
gained in our late war in regard to these wounds, it 
would have considerably enhanced the value of this 
portion of the work — at least to the American 
reader. 

Injuries and diseases of the nerves are very unsatis- 
factorily treated, and in no way is it a creditable chap- 
ter to its author, not being up to the requirements of a 
Avork of this kind. Little or nothing is said in regard 
to wounds of nerves, and the various operations that 
of late years have been performed for the relief of neu- 
ralgic affections are not even alluded to. 

The succeeding chapter, however, on aneurism, is 
very well written. While referring to ligature of the 
innominate artery, we find the statement made that it 
has been tried in eleven cases, and that they were all 
fatal. No reference is made to Dr. Smyth's successful 
case, which we believe makes the twelfth reported 
case of ligature of this vessel. Here, as in very many 
portions of the work, Mr. Gant appears to have been 
utterly ignorant of what has been accomplished in sur- 
gery on this side of the water. 

The chapter on fractures gives us a good description 
of tliese lesions, and is well illustrated by the time- 
honored woodcut?. The treatment, however, recom- 
mended in this work must strike American surgeons in 
many cases as somewhat antic|uated. For fractures of 
the femur "we find that Liston's long straight splint will 
be found most effectual in all fractures of this bone, 



and extension is to be made by confining the foot to 
the splint by a figure-of-eight bandage ! 

What has been said in regard to fractures applies 
also to dislocations. The principal obstacle in reduc- 
tion our author attributes to the muscles, and but little 
reference is made to the ligaments, which we believe 
at the present day are regarded by many as offering the 
chief obstacles to reduction. No reference is made, 
while speaking of dislocations of the hip, to Dr. Bige- 
low's work on this subject, and only brief reference 
is made to reduction by manipulation. 

With regard to the chapter on diseases of the eye, it 
may be considered as a slight improvement upon the 
manner Avhich we find these diseases treated upon in 
the majority of text-books on surgery. Had Mr. Gant 
followed some other ophthalmologist than Mr. Dixon, 
we have no doubt the chapter on diseases of the eye 
Avould have been more in accordance with the present 
state of ophthalmology. 

Though this work is faulty in many respects and in- 
vites criticism, there is much to be found in its pages 
which will be very valuable either to the student or 
practising surgeon. Under this head Ave would espe- 
cially refer to the articles on resection of the joints, inju- 
ries of the brain and spinal cord, together Avith the 
subject of curvature of the spine, and the chapter on 
the diseases of the genito-urinary organs. 

Mkdical Thermoaietry, and Human Temperature. 
By C. A. Wunderlicii, M.D., and Eda\^\rd Seguin, 
M.D. New York : Wm. Wood & Co. 1871. 

Within the past five years much attention has been 
paid to the use of the thermometer as a means of in- 
vestigation in clinical medicine and diagnosis ; and 
though A'ery man}^ practitioners Avere convinced of its 
value and utility, it has not as yet come into such ex- 
tensive use as it undoubtedly Avill hereafter, as Ave noAV 
have a concise manual on the subject to serve as a 
guide in the study of its use. The observations pub- 
lished in the Avork of Dr. Aitken Avere the first, we 
think, of any importance to call the attention of the 
profession to the real value of the instrument ; and 
though, from time to time, we have had more or less 
elaborate articles upon its use in various disea-es, we 
Avere AvhoUy in Avant of a hand-book treating of the 
AA'hole subject. Consequently, though the thermome- 
ter is quite largely used here, it may be said, Ave think 
Avith truth, that its use is nearly confined to thoscAvho 
have had opportunities for the study of its applicabilit y in 
the various large hospitals. Within a year Ave have had 
a translation ot the encyclopaidic treatise of Wunder- 
lich, which, besides being inaccessible to those Avho are 
not subscribers to the publications of the Sydenham 
Society of London, is objectionable on account of its 
great length and detail, and will be consequently 
of no reaf value to the majority of practitioners. To 
render this Avork available to American practitioners. 
Dr. Seguin has with great industry and care abridged 
it very materially, and at the same time has enriched it 
with a resume of his own extensive observations, and 
the result is a A'cry convenient and comprehensiA-e 
hand-book, Avhich is especially adapted to the Avants of 
the busy practitioner. The Avork is divided into two 
portions: first, the abridgment of Dr. Wimderlich's 
treatise; and second, the supplementary chapters by 
Dr. Seguin. 

We find in the opening chapters a concise and brief 
history of the instrument; followed by a consideration 
of the fundamental principles and of the art of medical 
thermometry, Avhich contain facts Avhich, Ave think, 
should be "thoroughly mastered. The observations 
upon local alterations of temperature in disease will no 



26 



THE MEDICAL KECORD. 



doubt bo novel lo mnny, and should be rosul in connec- 
tion with ihe ri-nmrks nia<lL' later on in the work by 
Dr. Se;ruin, who has devisu'd the surface-thi'rniometer 
to determine tliese local elevations. This instrument 
has by the zeal and .-kill of Dr. Se-juin, been brought to 
n hiph dcirree of perl'eolion, ami will no doubt be of 
essential .xerviee in clinical study. Among the other 
introductory chapters which deserve especial attention 
are those treating of typical alterations and of the daily 
fluctuations in disease. The various fel^rile diseases 
are then treated of in their order, and the tliermonie- 
trioal peculiarities of eacli clearly brought out. 

The observations appended by Dr. Seguin are in the 
highest degree practical, and materially enhance the 
value of tlic work; indeed, wc rarely find a foreign 
author's treati.se brought before the profession in such 
a masterly manner. The work is profusely illustrated 
by diagrammatic schemes, which add very much to its 
utility. 

The Sciences of Nature rersiis The Science of 
Man. a Plea fou the Science of Man. By Noah 
PoKTKit, President of Yale College. New York: Dodd 
& Mead. 1M71. pp. !)8. An Essay delivered before the 
Phi Beta Kappa Societies of Harvard and Trinity 
Colleges. 

Works of this class are much needed at the present 
time, when books on metaphysical questions are ecarce- 
ly intelligible except to the student. The subject is 
treated in a popular and entertaining manner, and is 
•well worth the attention of the general reader who seeks 
amusement coupled with instruction. The larger 
part of the essay is a terse review of the philosophies 
of Comte, Mill, Spencer, Iluxley, Darwin, etc., and 
demonstrates conclusively that they will not stand the 
tests which they themselves apply "to otliers. The au- 
thor shows that all other sciences rest upon the science 
of man as the foundation, and that, without a know- 
ledg3 of this as a basis to start from, the pursuit of the 
others is difficult and uncertain. 

The volume is correctly printed in clear type, on 
good paper, and is one of the many valuable productions 
which liave been recently published by this well-known 
publishing house. 

PKOCEEDrNGS OF THE ACADEMY OF NATURAL SCIENCES 

OF PiiiLADEi.PiirA, Part II.— April to September, 
1871. inclusive. Philadelphia, 1871 ; pp. 274. 

Tins number of the published proceedings contains 
several interesting articles ; for example, the paper of 
Prof. Marsh On Some new Reptiles and Fishes from 
the Crustacean and Tertiary Formations, discovered 
during the exploration of the Yale Scientific Party in 
the Rocky Mountain region, last summer ; On Remains 
of Extinct Mammals from Wyoming, by Joseph Leidy, 
M.D. ; and a paper by Elliot Coue.«, consisting of Notes 
on the Natural History of Fort Macon, N. C, and vicinity 
(No. 2). ' . J 

Mr. Isaac Lea contributes the descriptions of twenty 
new species of Unimidte of the United States; and Mr. 
F. B. Meek, the descriptions of new species of fossils 
from Ohio and other Western States and Territories; 
and the notice of a new Brachiopod. 



Twins in Pennsylvania. — The census statistics show 
the following I'acts: One family in Pennsylvania is 
credited with seven pairs of twins ; one with six pairs ; 
and another with four pairs. The motlwr of the last 
group has six other children, and is only thirty-eight 
years of age. — Med. and Surg. Reporter. 



llciu instruments. 



A NEW NEEDLK-FOTirEPS. 
Bv J. S. PROUT, M.D., 

HCnOEON TO THE DIIOOKI.YN ETE AKD EAR IIOKITTAU 

TiiEHE are certain objections to nearly all of the needle- 
forceps used ill operations on the eye, especially to 
those which are closed with a spring catch. I have 
seen the best of these, in the most skilful hands, tear 
the needle out of the conjunctiva in consequence of the 
jerk or jog communicated by the spring to the instru- 
ment in releasing the needle. To obviate this objection, 
Messrs. Tiemann <fc Co. made for me the forceps of 
wliich the accompanying cut is a reduced representa- 
tion. As now made, it is 4^ inches long, very light, 
and when closed occupies scarcely more space than an 
ordinary lead pencil of the same length. The figure 
shows its construction and action so well that it seems 
uimecessary to describe it. In u.se, the jawsgrasp the 
needle very firmly, and are kept securely closed by 
the sliding catch, upon the roughened head of which 
the thumb rests. The elasticity of the arms of the 
handle opens the jaws to the proper extent. The little 
pin at the end is to prevent separation and lateral mo- 
tion. 




The forceps has very successfully stood the test of 
use in my hands, and is found to be a favorite with 
those who need such an instrument. 

After it was made, I learned that the device for 
separating the jaws was not new, as I had supposed. 
I have seen since then a nearly similar needle-forceps 
of prior construction. 

ily friend. Professor Skene, tells me that this forceps 
(of larger size, of course) will be a valuable addition to 
the instruments used in operating on the perinaeum and 
within the vagina. 

Brooklyn, N. Y., Jiinnwy 6th, 1S72. 



CURVILINEAR FORCEPS FOR FACILI- 
TATING THE LIGATION OF HEMOR- 
RHOIDAL TUMORS. 

By WILLIAM BODENHAMEE, A.M., M.D., 

SEW SORK. 




I WOULD respectfully call the attention of the profession 
to the curvilinear forceps represented by the accom- 
panying wood-cut. Its construction is exceedingly 
simple, and its mode of action novel and effective. It 
was expressly designed for the purpose of temporarily 
compressing the basis of hemorrhoidal tumors, especially 



THE MEDICAL RECORD. 



27 



when large. This compression it firmly and most ef- 
fectually makes in a uniform manner, thus preparing,' 
the tumor for the more easy and ready adjustment of 
the ligature upon its already compressed and strangu- 
lated base. By the use of this instrument tiie operator, 
without the aid of an assistant, is enabled to apply, 
adjust, and tighten the ligature with the greatest facility 
and precision. 

The instrument was not intended as an tcraseur, but 
it will at once be perceived that it can be easily and 
successfully so employed. It will also be readily ob- 
served, from the construction and the operation of it, 
that with slight variation it is peculiarly adapted as an 
ovariotomy clamp. In this respect, if it is not supe- 
rior, it is at least not inferior to any ovariotomy clamp 
extant, so far as my knowledge extends. Should it 
prove to be so it would be important, for a good in- 
strument for such a purpose is just now a deside- 
ratum, inasmuch as it appears to be the general opinion, 
and gradually becoming the settled conviction, of the 
most distinguished ovariotomists, that the very best 
treatment of the ovarian pedicle is to clamp it, either 
permanently keeping it external to the abdominal 
wound, or clamp it temporarily until it is completely 
ligated. It may also be applied to other and various 
surgical uses. 

It will be seen from the drawing that this instru- 
ment, which needs but little explanation, has two 
blades curved on the edges, with handles curved on the 
flat. One blade ha= a fenestra its entire length, through 
which the other must pass in approximating or closing 
them. The coapting surfaces of the blades are rough, 
so as to secure a stronger hold and prevent the tissues 
from slipping. The handles are so curved that they do 
not press upon or otherwise interfere with the sur- 
rounding parts. The screw in the handles gives addi- 
tional security during the operation, and obviates the 
necessity of an assistant. The forceps are removed as 
soon as the ligature is tightened. 

The instrument was made by Iklessrs. George Tie- 
niann & Co., 67 Chatham street, New York. 



|3ro0rcss of ittetiical Science. 



The following is an extract from a report of the (Jan. 
12, 1872) meeting of the Society of Physicians of 
Vienna, sent us by Dr. W. T. Alexander, of that place: 

The Dr.\GNosi3 of Syphilis, from Microscopic Ex- 
amination OF THE Blood. By Dr. Lostorfer. — For 
a long time attempts liave been made to discover the 
bearer of the contagion in syphilis. Hallier examined 
the blood of those suffering from the infection, and dis- 
covered a parasite, the micrococcus. The correctness 
of this discovery was doubted from many quarters. 
For this reason mainly the results of examinations of 
blood have remained, until now, unsatisfactory. The 
speaker believes that he has found the explanation of 
this in the fact that the examiners did not work with 
sufficiently high powers ; further, that the examinations 
were almost entirely limited to /res/i blood, which was 
believed to be more suited to examination. The speaker, 
in his researches, had avoided both errors. 

Dr. Lostorfer began his examinations in August of 
the preceding j'ear, Prof. Zeissl having, with the 
greatest readiness, placed the material of his division 
at; his disposition. The blood was taken from sj'phi- 
litic individuals, and after periods of from three to four 
days Dr. L. found constantly present small, shining 
corpuscles, on which he could sometimes discover 
processes jutting out. It was proven that tlipse cor- 



puscles increased by budding. New corpuscles were 
formed in this way, which again increased by sprouting. 
By the addition of different fluid.s, especially sugar- 
water or Pasteur's fluid, these corpuscles became shriv- 
elled. 

This result was so constant that Dr. L. was enabled 
to diagnose syphilis with certainty and precision, by 
observing the development of these corpuscles. He 
had undertaken eight or ten test examinations, which 
were given him partly by Prof. Strieker and partly by 
Prof. Hebra, and every time he told correctly, from 
microscopic examination of the specimens, which blood 
was taken from syphilitic and which from non-syphilitic 
subjects. 

After having in this manner found his discovery tried 
and proven to be correct, he designated the little bodies 
by means of which he could certainly diagnose syphilis, 
as " syphilis-corpuscles." As regards their manner of 
development, the speaker said that it differed according 
to their number. In some cases more than filty were 
seen in the field, in others a much smaller number. 
He also perceived a difference in regard to the time of 
their development. Sometimes they budded on the 
third, sometimes on the fifth day ; in many cases, 
indeed, in twenty-four hours. As regards temperature, 
observation teaches that a too low degree of heat retards 
their development, but that the process went on unim- 
peded by variations of from 10 to IS'' Cent. Difler- 
ences in the manner of sprouting were also observed. 
Whether these syphilitic corpuscles are developed from 
the disease, or whether their germs pre-exist in the 
blood, and are only hastened in development by the 
infection, is still unsettled. He hoped by further exam- 
inations, in which he would be aided by Prof. Strieker, 
to become able to settle this question. 

Towards the close of his remarks the speaker 
described the class of cases from which his examina- 
tions were made ; they were patients from Prof Zeis.srs 
division, suffering from the most diflerent secondary 
and tertiary manifestations. It was noteworthy that, 
as improvement took place under the use of various 
anti-syphiUtic remedies, the syphihs corpuscles de- 
creased in number in the same degree, and finally 
disappeared entirely from the blood. 

Prof Skoda took the floor in order to congratulate 
Dr. Lostorfer upon his discovery, which would make 
an epoch in syphilodology. He remarked that it was 
unfortunate that Ave had no prizes to distribute, but 
that in Paris Dr. L.'s labors would certainly be crowned 
with a prize. 

Prof Strieker confirmed the statements of the 
speaker, and related the details of the manner in which 
the specimens of blood were delivered to Dr. Lostorfer, 
and how he from them designated those which had 
been taken from syphilitic patients. He had added 
some of his own blood to the number of the test pre- 
parations, in order to have absolute proof that it was 
not syphilitic. 

Prof Hebra also confirms the favorable and surpris- 
ing results of the test examinations. Kohn had also 
later seen the same objects in syphilitic blood. It was 
remarkable that Dr. Lostorfer recognized Strieker's 
blood among the numerous preparations. He had ex- 
pressed himself that " this specimen was Strieker's 
blood; it contained so many dirty elements." There 
must be, therefore, certain peculiar characteristics which 
pertain to the blood of non-syphilitic subjects also, and 
by which other dyscrasife are to be recognized. He 
had been led by this thought to conceive the idea of 
having the blood of small-pox patients examined in 
the same manner, in order to discover if some specific 
diagnostic signs could not be discovered. 



28 



THE MEDICAL RECORD. 



DunETKS IX IxprA. — The subjoined intcrcstinj^ ar- 
ticli' on diabetes occurs as an editorial in I'.ie Indian ! 
Medical Gazette, Calcutta, December 1st, 1871 : — 1 

It seenn stianpe, considering tlie frequency with ' 
wiiieli diabetes is met with amon;^ tlic natives of this | 
part of India, that so little should be known of its cir- I 
eiimstances. In Dr. Gouverncur M. Siniih's latest and 
most valuable corhniunication to the New York Medi- I 
cal Society (should be New York Academy of Medi- ' 
cine), he remarks that, so sli-riit is his knowledge with 
reference to the disease in India, that he can hardly i 
determine if it even exi^t^s among the natives of the j 
cotmtry. In New York, during the year 18G8, the ' 
ratio of deaths from diabetes to the population was I 
1 in 100,000. We are certainly not in a position to 
give any figures on this point, but our impression is that 
among the upper and middle classes of natives in Cal- 
cutta, almost every family has lost one or more of its 
members from diabetes. We can at any rate assert 
with confidence that the disease is frequently met 
with among tlie classes referred to, l)ut as j'ct we are 
absolutely ignorant of all that concerns its history from 
a medical point of view, and we look to the native 
medical practitioners of the place to enlighten us on 
tho subject; many of them must have had very con- 
siderable experience in cases of diabetes, and we 
should very nmch like to get their opinions on several 
points connected Avith the clinical study of this formi- 
dable disease. 

We might, in the first place, seek for information re- 
garding any cases in which diabetes appears to have 
keen an hereditary disease. A very remarkable in- 
stance of this kind has, for example, been placed at 
our disposal by Baboo Satcory Dult, and has reference 
to one of the most highly respectable and influential 
families in Calcutta. 

No. 1, Baboo B — , died at the age of Go, of acute 
diabetes, which lasted only twenty days. 

No. 2, the eldest son of No. 1, died of chronic dia- 



betes 

No. 
No, 



3, the third son of No. ], had chronic diabetes. 

4, the fourth son of No. 1, died of acute diabetes. 
No. 5, a daughter of No. 1, now aged 65, has dia- 
betes. 

No. G, the eldest son of No. 2, grandson of No. 1, 
di d of chronic diabetes. 

No. 7, the second son of No. 2, has diabetes. 

No. 8, the eldest son of No. 4, has diabetes. 

In addition to the above, two widows of the family, 
wives of No. 3, died of diabetes. 

This is certainly a very remarkable case, for, as Dr. 
Gr. M. Smith writes, there are very few reliable data 
in relation to the hereditary transmissibility of diabetes. 
There can be no possible doubt as to the above facts, 
and it is just such an example of that kind of informa- 
tion we are much in want uC. 

Then, again, with reference to the relative frequency 
of the disease among males and females. Dr. G. M. 
Smith arrives at the conclusion that it is equally com- 
mon among members of both sexes. We were in- 
clined to think diabetes far more frequent among males 
than females in this country. The case above stated, 
however, rather points to the correctness of Dr. Smith's 
opinions. Any facts bearing on this point would be 
most interesting in a clinical point of view, as bearing 
upon the etiology of the disease. 

We should be very glad to draw forth information 
from our native friends^ as to the influence of diet on 
diabetes. Are the members of those sections of so- 
ciety who do not abstain from animal food more sub- 
ject to the disease than those who rigidly confine them- 
selves, from childhood to old age, to amylaceous and 



saccharine food ? This is a question which is of the 
greatest interest, bearing as it does directly on tiie cir- 
cumstances of the disea'^c, and the various theories that 
have been advanced to account for it. The field of ob- 
servation open to practitioners in this country is ab- 
solutely unique in this respect, and can hardly have . 
failed to attract the notice of some of our professional 
brethren. Tlie mortuary statistics of the native army 
and jails might very possibly afi'ord information to those 
who have time and inclination to advance our know- 
ledge regarding diabetes in India. 

Abscess of the Skptim Narium. — Dr. D. 11. Good- 

willie, of New York, reports the following : — Mrs. , 

aged 6G years, presented hcnself some time in October, 
18G7, with an ab.scess of the septum narium, filling up 
both nostrils. This was the result of an injury from run- 
ning against an open door in the dark. The swelling 
was siiining, red, tender on pressure, with fluctuation. 
Inflammation extended to frontal sinuses, as she com- 
plained of severe headache. Opened freely on both 
sides with a lancet, and found the ab.scesses communi- 
cated through the septum. Dressed by introducing 
the point of a small syringe into the wound on one 
side and washing out the cavity, the fluid passing out 
by the other side. A tent was introduced by means of 
a curved needle through the opening in the septum, the " 
ends of wdiich passed out of each wound. Tent re- 
moved on third day, and the wounds soon healed. 

Sulphite of Soda in Variola. — Dr. Maurice Pflaum, 
of Pitt.sbiirgh, Pa., comes to the conclusion that sulphite 
of soda, given at an}' time before the eruption has fully 
come out, will invariably cut short the disease, even 
more eflectually than quinine does intermittent fever. 

Yellow Fever — its Pathology and Treatment. — 
Benj. S. Purse, ^I.D., of Savannah, G-a., Avrites: — I was 
led to the consideration of this disease in the early 
part of the past summer, by the fact of its prevalence 
in the city of Charleston, S. C. I then arrived at the 
following conclusions as to its pathology and treat- 
ment, and determined to test their truth upon the 
first opportunity: — Yellow fever is never endemic nor 
epidemic except in localities in which malarial fever is 
endemic. These two fevers resemble each other very 
much in their symptomatology, and at times the diag- 
nosis between them is impossible. This resemblance 
is increased by the fact that the functions of the liver 
are markedly disordered in both diseases. Owing to 
these facts, even at this late date, there are physicians 
who believe that yellow fever is but an aggravated 
type of malarial fever. But they are essentially dis- 
tinct diseases, originating from tino specific poisons. 

The malarial poison acts primarily upon the sympa- 
thetic nerve centres, and through them deranges the 
functions of all the organs sustained by that system of 
nerves, and is the onl}' true ^' nei-vous fever." The 
yellow-fever poison acts directly upon the cell-structure 
of the liver, tending to produce molecular death of that 
organ. When the fimction of the liver is entirely sup- 
pressed, that organ becomes a mechanical impediment 
to the circulation, and as effectively so as a ligature 
around the portal vein would ; because the portal 
circulation is continuous with the systemic circula- 
tion, through the medium of the capillaries, and the 
capillary circulation is controlled by the cell-structure 
which they supply. When the cells cease to perform 
their function, their capillary circulation also ceases. 
The suppression of the function of the liver in this dis- 
ease, as a rule, is gradual, and is the result of the pro- 
gressive death of the cells. In some cases, howeve r, 
the liver is killed, as it were, by a blow, and the 



THE MEDICAL RECOKD. 



29 



patient dies before those changes in its structure, so 
characteristic of this disease, have been developed. 

It is a general law of the body, that when any organ 
has served its purpose, its cells undergo fatty degener- 
ation and are absorbed, leaving its connective tissue to 
mark its Ibrmer site. 

This normal degeneration and absorption of organs 
is caused by the tuilurc of their cerebro-spinal nerves, 
which control their blood supply ; while their sympa- 
thetic nervous inlluence being unimpaired, they do not 
suppurate, but degenerate into a fatty condition. The 
cells dying from inanition, the yeilow-fever poison pro- 
duces this condition of the cells in the liver, but in a 
different manner. In the former case the supply of 
blood ceases, while in the latter the cells are paralyzed. 
Carbonic oxide causes a similar paralysis of the blood- 
corpuscles. When the circulation through the liver 
ceases, the portal vein and all the veins emptying into 
that vein become congested, until filled to their utmost 
capacity. The capillaries connecting these veins with 
the arteries, being unable to relieve themselves of the 
vis a tergo, receive the full force of the heart's action, 
which soon overcomes the comparatively slight resis- 
tance offered by their simple attenuated walls; and 
capillary hemorrhages take place from the mucous sur- 
faces of the organs which supply the portal blood. 
Each drop of blood, as it falls into the stomach and 
intestines, is coagulated by the acid secretions there 
met with, producing the material which is known as 
'^ Black Vomit" and "Black Vomit Stools." 

Disorders of the liver always give rise to frontal 
headache, and the pain is in proportion to the acute- 
ness and severity of the liver disease. In agreement 
with this rule, yellow fever is characterized by a pecu- 
liarly intense frontal headache. The albuminuria is 
caused by the liver disease. All cases of albuminuria 
Avhich are not caused by disease of the kidneys jjer 
se, late pathologists generally agree in ascribing to 
some as yet not definitely ascertained disorder of the 
liver. My opinion is, that it is caused by a gradual 
degeneration of the cells of the liver. An analogous 
disease is described by Dr. Flint, Sr., Avhicli he calls 
"Degeneration of the Gastric Tubules." It is a dem- 
onstrated fact that the albuminous principles of the 
blood are converted, by their passage through the liver, 
into the saccharine principles, which in their turn are 
decomposed in the pulmonary circulation. When 
either of these organs fails, the excess of albumen or 
sugar, as the case may be, is exci'eted by the kidneys. 
The albumen, generally, does not appear in the urine 
until about the third day. The pulse, as a rule, does 
not exceed one hundred, and is full and hard, indica- 
ting plethora of the blood-vessels. 

This plethoric condition is the result of the two fol- 
lowing causes: 1st. By the inaction of the liver, the 
volume of the blood is not reduced by the conversion 
of its albuminous principles into the substances which 
are excreted by the lungs, kidneys, and skin. 2d. 
While the excretions are lessened or entirely suppressed, 
the lymphatic or albumen producing organs continue 
comparatively active. These two causes co-operating, 
produce a fulness of the systemic circulation, notwith- 
standing the excessive congestion of the portal circula- 
tion. 

I suggest the following treatment, believing that if it 
be commenced with early in the disease, it will exer- 
cise an almost specific influence. As soon as the 
patient is seen, without regard to the s'age of the dis- 
ease, apply a large warm poultice to the epigastrium, 
repeating from time to time if necessary. Fjfteen min- 
utes after the application of the poultice, administer 
one teaspoonful of each of the following solutions, in j 



an ounce of water. Repeat trie same dose every hour 
until cinchonism is produced. 

I?. Potass brom ^ i. 

Aqua ? iv. 

M. Sig. : Teaspoonful every hour. 

I^ Quinia sulph 3 i. 

Arom. sulph. acid f. 3 ij. 

Tr. opii camph.. 

Aqua an f r i. 

'M. Sig. : Teaspoonful every hour. 

When cinchonism is present, continue the bromide 
potassium alone every hour, giving only an occiisional 
dose of the quinia solution. If necessary, relieve the 
bowels by the Seidlitz or other saline, or by enemata. 

The above combination of quinia, arom. sulph. acid, 
and tr. opii camph. has never failed, in my experience, 
to stop the nausea and vomiting so common in mala- 
rial fevers. I have repeatedly used it with patients 
suffering with high bilious fever, whose stomachs were 
so irritable that upon the least attempt to swallov/ even 
cracked ice, produced violent retching and vomiting, 
and in several instances a slight hemorrhage from the 
stomach, who were immediately relieved by ihcjirst 
dose of the remedy. It is one of the surest, quickest, 
and most powerful diaphoretics, the third or fourth 
dose usually causing a profuse perspiration. I have 
frequently subdued in twelve hours severe bilious 
fevers of three and four days' duration with it alone. 

This combination meets three of the indications in 
the treatment of yellow fever, viz. : 

1st. It relieves the nausea and vomiting. 2d. It 
produces a powerful action of the skin. 3d. It is a di- 
rect tonic to the liver, the quinia having a specific 
effect upon the sympathetic nerve. 

Bromide of potassium is almost specific in albuminu- 
ria. It almost uniformly produces absorption of drop- 
sical effusions, irrespective of their cause, and without 
sensibly increasing the secretions unless they have 
been suppressed. It relieves congestions in every part 
of the body, particularly of the brain. It is the remedy 
in congestive and nervous headaches. It is a poAverful 
sedative ^to the brain and spinal axis. It produces a 
sedative action on mucous membranes. It will relieve 
suppression of the urine. Possessing these thei-apeutic 
properties, bromide of potassium meets the other two 
indications in the treatment of yellow fever, viz. : 1st. 
The intense frontal headache. 2d. The albuminuria 
which is always developed in grave cases. For the 
albuminous feature in this disease, I give the bromide 
upon the theory that, as it is curative of albuminuria, 
by administering it in anticipation of this grave symp- 
tom we prevent its development. If this were not suf- 
ficient reason for its early use, we have still another, to 
relieve the head symptoms. 

Rachitis. — Dr. John S. Parry, Accoucheur of the 
Philadelphia Hospital (Am. Jour. Med. Sciences) says 
that this affection is not confined to children who are 
inmates of hospitals ; moreover, it is not among the 
poor alone that it is met with, notwithstanding Meigs 
and Pepper cannot corroborate the experience of 
Jenner, Avho has " very often seen it among tlie children 
of the wealthy." 

He has been irresistibly forced to the conclusion that 
this disease is scarcely less frequent in Philadelphia 
than it is in the large cities of Great Britain and the 
Continent of Euroj^e, and that it should occupy just as 
important a place in our mortuary lists as Hillier con- 
ceives that it should in those of the Registrar-General 
of England. It is probably true that the disease is 
rarely congenital, but to say that " it is never born with 



no 



IIIK MKDir'AI. llEf'ORD. 



the cliiltlrcn " (Bocrhoave's 1487lh npliorism), he 
lu'lievcs all will have to admit is poin;,' too far. In 
view of recor«K'»l facts, rachitis is sometimes, thoiif,'h 
rarelv, confjonital, ami may result in considerable de- 
formity even before birth. It is not by any means 
rare durinp the early months of extra-ulenne life. Tiie 
writer has met with uneciuivocal bending of the ril)8at 
six weeks after birth. It is rare for it to be^-in after 
tlic end of the first year. He ha3 seldom met with it 
in a child in wliom no .symptoms of the aflV'ction pre- 
sented themselves before this time. A common .source 
of error is the failure in discriminating between rachitis 
and mollities ossium. IJromfield, Sianley, Bcylard, and 
Stewart have committed this error. Racliitis is proba- 
bly more than any other a disease of childliood, and 
even of infancy, while mollities ossium is an affection 
of adult life. 

AcostTE PoisoNi.vG. — Dr. Stephen S. Keenc, Prov- 
dence, K. I. {Boston SM. and Surg. Journal), publishes 
a case of poisoning by the external application of 
aconite. For pain in riiiht side of the face, he applied 
a portion of the following mi.Kturc to the affected part 
by rubbing with the fingers. I>. Tinct. rad. aconiti, 
Tinct. opii, il a 3 ss. M. One liaif hour afterwards he 
was .seized with dizziness, nausea, dimness of sight, 
cephalalgia, pain in back, with sensation of coldness 
running along tlie spine, etc. One hour after the ap- 
plication, the usual results from an overdose of aconite 
internally were exhibited. On examination, no abra- 
sions were discovered on face, but the index finger 
of right hand had a slight wound. The patient, male, 
aged forty-five, of good constitution, was treated with 
ammonia and cldoroform, and at the end of forty-eight 
hours the symptoms subsided. 

C.\Tn.\RTics IN' Albuminuria — Dr. Moore, of Pioches- 
ter, X. Y. (Med. and A^urfj. Reporter), read a paper 
before the Central Xew York Medical Society, in which 
the idea was enforced that albuminuria might remain 
as an organic disease for a considerable length of time; 
and during that time there was a remedy in sulphate 
of magnesia. A case was presented, in which the con- 
dition of albuminuria was removed by the cathartic 
treatment. 

Drs. Benedict and Campbell gave histories of cases 
which had been managed according to Dr. Moore's 
plan, which afforded relief. 

In answer to Dr. Mowris, whether the saline treat- 
ment had been successful after scarlet fever. Dr. Moore 
replied affirmatively. 

Large Pleuritic Effusion Treated by Thirst. — A 
case in winch this mode of treatment was pursued 
by Dr. Moxon, in Guy's Hospital, is reported in the 
Medical Times and Gazett'' of January 6th. At the 
commencement of the treatment the right pleural 
cavity were filled with liquid.- The drinks of the patient 
were Umited to ten fluid ounces per diem, and five 
grains each of iodide of potassium and muriate of 
ammonia were given three times daily. By the middle 
of the third week of treatment dulness on the affected 
side had disappeared. 

Presence of Bacteria in the Blood during Ery- 
sipelas. — Dr. Nepveau reports, in the Gazette Mtdicale 
de Paris, four observations, made with a No. immer- ' 
sion of Ilartnack's make, on blood taken from patients 
suffering with this disease, and says: — 

1. Bacteria exist in considerable numbers in blood 
drawn by puncture from a surface affected with ery- 
sipelas; three to five, and sometimes as many as seven, 
having been at one time in the field of the microscope. 



2. Bacteria exist as well in blood drawn from other 

fiorlions of the body than those affected witli erysipe- 
atoiis inflaminalion ; they are not so numerous as in 
blood drawn from the disea.sed surface, but can almost 
always be found in any drop of blood submitted to 
examination. 

3. In all the ca.ses examined the bacterium punctum 
of Ehrenberg was the one observed. 

4. They ajipcar t) be present in ca.ses of .so-called 
idiopathic as well as in tho.*^ of traumatic erysipelas; 
but it remains to be established whether or not this is 
constantly the fact. 

Xylol is the name of a new hydrocarbon lately in- 
troduced to the materia inedica in Germany. Wiien 
pure it is colorless and has a faint odor, somewhat like 
benzole. Its specific gravity is 80G, an<l its boiling 
point 139" C. Xylol, or xylene (Cn IIio), was first 
separated from coal naphtha l^y Dr. Hugo Midler, and is 
obtained by fractional distillation until a distillate is 
obtained of about 140' C. boiling-point; this is mixed 
with sulphuric acid, whi<;h dissolves xylol, forming 
xylol-sulphiiric acid, which is decompo.sed by dry dis- 
tillation, and the xylol thus obtained is further purified 
to render its use safe. Its specific action is not, as yet, 
very well understood; but it has been administered in 
small-pox with such really good results that it bids fair 
to be an important remedy. Dr. Zuelzer, Senior Phy- 
sician at the Charity Hospital, Berlin, has used it with 
" complete success " in the above affection. It is given 
in capsules, in doses of from 3 to 5 drops for children, 
and 10 to 15 for adults, as often as every one, two, or 
three hours. As much as a tea.spoonful has been taken 
at one time without injurious effects. — The Pharmaceu- 
tical Journal. 

Effects of Various Liquors on the Kidneys and 
Bladder. — Kraus, of V'ienna, says, speaking of this 
subject: '"Sparkling wines are very injurious in dis- 
eases of these organs, but not on account of their 
carbonic acid, which assist? materially in the elimina- 
tion of the phosphates. Champagne not only increases 
the secretions, but, in an extraordinary manner, the 
phosphates; and the conduct of medical men who ad- 
vise its use in cases of calculus cases is very repre- 
hensible. His experience absolutely contradicts the 
idea of the solvent action of carbonic acid in concre- 
tions already formed. Old beer he considers unob- 
jectionable ; but new beer is to be avoided, because 
the fermenting principle enters the mucous menu 
brane, and gives origin to a greater or less degree of 
catarrh. English pale-ale is open to the same objec- 
tion on account of its richness in alcohol and carbonic 
acid; porter, however, if of good quality and age, he 
considers to be also unobjectionable. 

On the Diagnosis and Treatment of Scrofulous An- 
GiN.E. — Dr. E. Isambert, of Paris, writing in The Pr-ac- 
titioner of these affections, calls attention to the limited 
space devoted to this subject in works on pathology, 
and the fact that their distinctive characteristics are 
not well appreciated; being frequently confounded with 
those of syphilitic, tuberculous, or malignant degenera- 
tions of the pharynx and larynx. It is, he says, before 
all chronic affections, the almost indolent, and is seldom 
attended with hypertrophy of the cervical glands. Stru- 
mous catarrhal angina has no very well-defined char- 
acter ; the foUiculitis and the amygdalitis with which 
it is accompanied being distinguishable from analogous 
affections only by considering the general habit and con- 
stitution of the patient. Scrofulous ulcerations of the 
pharynx constitute, on the contrary, a pathological 
type which may be recognized. They are to be met 



THE MEDICAL RECORD. 



31 



•with, according to their order of frequency : first, on 
the posterior surface of tiie pharynx ; next, on the soft 
palate and its arches; seldom on the tonsils, on tlie pa- 
latal portion of the pharynx, and towards the Eustachian 
tube; lastly, towards the epiglottis, the arytenoid emi- 
nences, and tlie laryngeal infundibulum. They are al- 
most indolent, and are not attended, in the great ma- 
jority of cases, by inflammation of the cervical glands. 
This localization at the outset, tlie absence of all in- 
flammatory and painful phenomena, and of any exten- 
sion in the direction of the cervical glands, serve to 
distinguish them clearly enough from syphilitic ulcer- 
ations, which make their first appearance on the soft 
palate, are surrounded by a more extensive circle of 
inflammation, and are attended by greater pain and by 
inflammation of the cervical glands. 

The appearance of the scrofidous ulcers is pretty 
similar to that of the slightly eroded syphilitic patches ; 
but they do not present opaline or iridescent aspects, 
■which in the mucous syphilitic patches form a marked 
contrast with the carmine color of the inflamed circle. 
The ulcerated patch of scrofula, though irregular and 
sinuous like that of syphilis, is more pallid and of a 
yellowish color, like that of subcutaneous areolar tissue. 
It is but slightly depressed, and presents a rugged 
surface, more or less covered with small eminences. It 
is surrounded by an inflammatory circle of small ex- 
tent and slight thickness, not at all loosened, and 
blending in an insensible manner with the ulcerated 
surface. Th's border speedily resumes its normal as- 
pect under the influence of local treatment. Whilst the 
syphihtic patches of the pharynx are well enough de- 
fined, and are bathed by abundant and limpid saliva, 
scrofulous ulcerations are covered by a very viscid and 
adherent muco-purulent or whitish pultaceous secre- 
tion. In the graver cases we may observe on the 
pharynx a dirty or earthy-gray coating, which covers 
all the surface and gives origin to a more or less offen- 
sive smell; and yellowish, acuminated pimples, like 
small furuncles. These strumous manifestations may 
make their appearance without being preceded by other 
scrofulous phenomena in the neighborhood. 

However, the deformities and morbid adhesions of the 
soft palate and its arches, which are sometimes observ- 
ed on the first examination of the patient, would show 
that previous outbreaks of the disease had taken place. 

The iodo-mercurial treatment modifies pharyngeal 
syphilitic manifestations in a very short time when 
they are not too inveterate. The same mode of treat- 
ment makes scrofulous ulcerations w"orse, and if after a 
few days of this treatment the symptoms of a case of 
pharyngeal ulceration are not improved, a tonic and 
anti-scrofulous treatment should be resorted to. 

When combated in time, and before the production 
of serious injuries to the pharynx, scrofulous ulcerations 
are easily cured. At the outset, aineudment takes 
place rapidly ; but tlie ulcers, after such changes, close 
very slowly, much more slowly, indeed, than syphilitic 
ulcers. They are then superseded by white cicatrices 
of a pearly aspect, set in small clusters, sometimes 
parallel to each other, and at other times radiating in 
all directions. As to the adhesions of the soft palate, 
it is only by the resort to surgical measures that we 
can hope to modify them. 

Deafness supervening upon obliteration of the Eus- 
tachian tube seems to be beyond the reach of the re- 
sources of our art. 

The previous history of the patient, and any con- 
comitant phenomena, will be of great aid in forming 
a diagnosis. 

Lupus of the face, or of the nasal fossae, will generally 
have preceded pharyngeal lupus. 



It is only when phthisis is far advanced, and pul- 
monary cavities exist, that we observe ulcerations of 
the jiosterior surface of the pharynx, and even then 
the ulcers arc small and quite superficial. 

Neither herpetism, arthritism, nor catarrhal anjiinai 
can produce ulcers which we should be liable to con- 
found with pharyngeal scrofula. It is hardly necessary 
to refer to pharyngo-laryngeal diphtheritis, whose 
course and pathological products are too special and 
well known to involve the diagnosis. 

Scrofulous lesions present none of the neoplasms 
peculiar to cancer, the offensive smell of the latter 
aiding, also, in the formation of a diagnosis. 

The treatment may be briefly summed up as fol- 
lows : — 

Absence from mercurial remedies; or, where there 
exists a positive mixture of syphilis and scrofula, a 
careful employment of that treatment, alternating with 
considerable periods of rest, during which the iodide 
of potassium or of iron may be employed. Second, 
speedy employment of the general treatment of scrof- 
ula: cod-liver oil in large doses, iodide of iron, cin- 
chona, wine, good food, out-of-door exercise, and 
sulphurous baths. Third, persevering employment of 
local treatment by means of the laryngeal sjionge, 
tincture of iron, either pure or mixed with opium. 
The ethereal tincture of iodoform, chloride of zinc, or 
concentrated chroinic acid, may be applied to the dis- 
eased surface. 

Chromic acid is admirably borne by the mucous 
membrane of the mouth, pharynx, and even the larynx, 
exerting a highly powerful action in oedema of the 
glottis, strongly astringing the membrane, and thus 
warding off the need for tracheotomy. 

Perchloride of iron has been employed, especially in 
cases of bleeding ulcers. 

Nitrate of silver does not seem to be of much benefit, 
unless when applied with the object of hastening the 
cicatrization when already in good progress. 

Various powders may be blown upon the surfoce, 
especially iodoform mixed with lycopodium. 

Local douches made with the irrigator may be very 
useful, and exert an anodyne action in certain cases. 

In respect to atomized fluids, he considers their ef- 
fects to be inefficient in such grave lesions. 

The most important part of all is to form, as early as 
possible, a correct diagnosis, so as to institute a rational 
treatment, and avoid hesitation, loss of time, and, above 
all, weakening measures which are absolutely contra- 
indicated. 

Chloride in Place of Bromide of Pot.\ssiu.m. — Dr. 
Lander has substituted the chloride for the bromide of 
potassium in the treatment of epileptics, with a success 
which he declares to be identical. He begins with 
smaller doses; but doses of 75 to 150 grains daily have 
been borne without inconvenience for months in suc- 
cession. He thinks that it is more active, says that it 
is one-sixth the price, and not followed by the unpleas- 
ant efHects of the bromide. He advances the theory 
that the latter is converted in the stomach into the 
chloride, and that, for many reasons, it is desirable to 
administer it at once in this form. 

Compressed Air as a Remedial Agent. — G. von Lie- 
big {Archiv f. Klin. Med.) seeks to determine, with a 
view to the therapeutics of chronic lung diseases, what 
influence is exerted on the respiration by increased or 
diminished atmospheric pressure. Respiration at high 
altitudes, with low barometric pressure, as is well 
known, is exceedingly difficult. This is due to the greater 
elastic recoil of the lung tissue from diminished atmos- 
pheric counter-pressure. Hence the difficulty of inspira- 



32 



THE MEDICAL RECORD. 



tion niul the disturbance of circulation. Under increas- 
ed barometric pressure, the phenomena are quite the re- 
verse ; respiratiou i-i usually decj) and easy, and the pulse 
becomes slower. The inlhuiiee of increased or dimin- 
ished pressure is not of momentary duration, but per- 
sists for some time. Residence at hitrh altitudes ha", 
therefore, a tendency to develop the respiratory power, 
and streupth generally. From the inlluence of dimin- 
ished atmospheric pressure on the lunp?, the advantages 
of resi<lonce at high altitudes in cai-es of eniphy.sema 
will be apparent. Emphysematous lungs, having lost 
their elasticity, and ofl'ering less resistance to the pulmo- 
nic circulation, may regain their tone, and respiration be- 
come easier. In all casi?sof diminishe<l elasticity of tissue 
from any cause, residence at high altitudes under low 
barometric pressure is advisable. 

DlST.\NCK OF THE ^^ACULA Ll'TEA FHOM THE OpTIC 

Disc. — In a recent number of the Cenlralhlntt, Dr. Ed. 
Londolt, of Zurich, states that, from careful measure- 
ments made by him in upwards of 100 e)'e.s, he has 
ascertained that in healthy, or emmetropic eyes, the 
distance of the macula lutea from the centre of the 
optic papilla, in a horizontal direction, is 3.015 millime- 
tres; the former, also, being 0.785 of a millimetre high- 
er vertically. The distance is always greater in hyper- 
metropic, and less in myopic eyes than is represented 
by thes2 figures. 

Digitalis a\ AxAniRonisiAC. — M. Gourvat, in the 
course of a paper published in the Gciz. Mid. cle Paris, 
on the action of digitali.s, says: '"When digitalis, or 
digitaline, is administered for some time to a man in full 
possession of sexual powers, these become gradually 
weakened, the propensities disappear, formation of the 
liquor seminis diminishes, and may at last cease alto- 
gether. The anaphrodisiac properties of the drug are 
the secret of its good effect in spermatorrhoea. With 
women, digitalis or digitaline excites strong, regular, 
and intermittent uterine contractions, and controls 
metrorrhagia ; hence digitalis is employed in producing 
abortions. (Tardieu.) It is probable that this drug 
acts as an ancphrodisiac in women, inducing, by long- 
continued use, impotence and sterility, appearing al>o, 
in their cases, to interf(,>re with the development of the 
Graafian vesicles ; the propagation of species being thus 
doubly retarded. 

Freqcenct of Laryngeal Ulceijatioxs in Syphilis 
is the subject of a valuable article in the Wiener Med. 
Press, from which the following figures are taken : — Out 
of 100 post-mortem examinations of patients affected 
with secondary syphilis, performed at Prague, Kiihle 
saw ulcerations of the larynx 15 times; whilst Alten- 
hofer met only 25 cases among 1,200 living patients. 
Gerhardtand Roth, on the other hand, found it IS times | 
in 54 syphilitic patients — viz., 11 times with 44 second- I 
ary patients, and 7 times with 12 tertiary ones. Out i 
of 1,000 syphilitic patient?', Lewin found 44 presenting | 
an a5"ection of the larynx and more or less hoarseness. , 
Engeftted counted 25 laryngeal cases among 521 
patients suffering from syphilis — viz., 14 cases among i 
292 men, and 11 ca=e3 in 292 women. Doctor Som- j 
merbrodt (the writer of the article) himself collected ; 
cases for nine months at the AUerheiligen Ho.spital; i 
and, out of 84 patients with constitutional sypliilis, 15 i 
presented ulcerations of the larynx in different periods, ' 
and 14 had catarrlial affections with hypertrophy of | 
the mucous membrane. These lesions seem, therefore, I 
rather frequent, as already stated by Tiirck in his j 
manu.ll. Among 2.38 cases of persons sufi'ering from i 
various laryngeal affections, says the author, 45 were 
syphihtic. Laryngeal syphilitic symptoms may occur in j 



all the stages of the disease. Tiirck observed them in a 
I patient who had had primary lesions thirty years he- 
lore ; and Krankel has s(>en such ulcerations in a child 
I two months old, with whom the first .signs of syphilis 
had appeared one month after birth. The earliest 
time alter primary lesions ha", in Tiirck's experience, 
' been six months; in Somiiierbrodt'.s, five months; and 
"j in Lewin's, from two to three month.s. The seat of the 
I lesions is indicated in the following table in 92 cases: — 

Epiglottis 21 timo.s. 



( both, 
True vocal cords ■ right 4 ^ 






/left 

( both 

False vocal cords < right 

(loft 

Interior of larynx } '^T'-"""!-' in r 
•^ / Anteriorly 10 ( 

Aryteno-epiglottic folds. . . . 

I'pper opening 

Right pyriform sinus 

Lower portion of the larynx 



9/ 



34 



It will therefore be seen that the vocal cords are the 
partsmost frequently attacked, especially the l>/t. This 
circumstance sliould be recollected, as, in Rhimer's 
experience, tubercular ulcers are mostly situated in the 
right, and this peculiarity has a diagnostic value. It is, 
in fact, towards the upper part of the larynx that the 
syphilitic ulcerations are formed. 

Strychnia a Retinal ano Optic Nerve Stlmclus. — 
Dr. Juliauj^J. Chisolm, Clinical Prof, of Eye and Ear 
Diseases in the Univ. ot' Maryland (Am. Journal of Mecf. 
Sciences), advocates the hypodermic use of strychnia in 
cases of optic nerve atrophy, and reports cases in which 
the effects seemed nearly instantaneous upon the injec- 
tion of the fluid under the skin. In nearly every 
instance'the patient experienced the brightening of the 
light in less than a half minute. Prof. Nagel, of Tiibin- 
gen, Germany, injects, in his cases, the temple, near 
the seat of the eye disease. As the strychnia has first 
to be absorbed, and only acts upon the nerve centres 
through the circulation, he sees no advantage in thi^ 
location over the arm, and hence uses this distant but 
more convenient portion of the body. He commences 
usually with the one-sixtieih of a grain, which is grad- 
ually increased to one-thirtieth, twice a day, in no case 
exceeding this last amount. This treatment has been 
tried in many cases, doing harm to none, and benefiting 
all more or less. In functional disturbances the relief 
is prompt; in organic troubles of the retina and optic 
nerve results show themselves more slowly. So far, 
his experience in the h3'poderniic use of strychnia 
enables him to indorse the statement of the wonderful 
effects secured by Prof. Nagel, of Tubingen, and he 
can recommend to the profession strychnia, hypoder- 
mically used, as a most valuable remedy in many cases 
of nerve-blindness. 

Amputation at the Knee-joint. — Two successful 
crises of this amputation are recorded by Dr. G. M. 
Staples, Dubuque, Iowa (Am. Journ. Med. Sciences). 
In regard to the length of the anterior flap, he states 
that the incision extended but a trifle more than an 
inch below the tubercle, and, as is seen, the cicatrices 
remain in the hollow behind the condyles, with non- 
retraction of the patella. If it is a matter of some im- 
portance to retain the patella at the end of the .stump, 
he asks, may not as short an anterior flap as is practi- 
cable and safe, with flexion of the thigh ujion the pelvis 
until union is effected, contribute to this result? 



THE MEDICAL RECORD. 



33 



Ueports Df Societies. 



MEDICAL SOCIETY OF THE COUNTY OF 
NEW YORK. 

Stated Meeting, January 22, 1872. 

Dr. Abraham Jacobi, President, in the Chair. 

TiTK following physicians wero reported from the Co- 
miiia Jilinora as recommended for membership, and, by 
vote of the Society, they were admitted, viz. : Alex- 
ander Perry, Charles M. FairbroLher, Nicholas L. Camp- 
bell, Julius H. Tyndale, Gustavus Treskatis, Herman 
Loewenthal, and L. De Forrest Woodruff. 

Tlie President announced the death of Dr. Henry 
D. Bulkley and of Dr. Alexander N. Gunn. On mo- 
tion, Drs. D. C. Carr, D. A. Hedges, and S. W. Roof 
were appointed a committee to draft appropriate reso- 
lutions in the case of Dr. Gunn. Resolutions on Dr. 
Bulkley's death had been adopted at the Special Meeting 
which we have already recorded. 

DISEASES OF THE PAST YEAR. 

The report of the Committee on Diseases was read 
by its chairman, as follows : — 

The Committee on Diseases has the honor to present 
the following report upon the mortality and prevailing 
diseases of the past year : 

The total mortahty of this city for 1871 amounted to 
26,976 — a decrease of 199 from the previous year. It 
was equivalent to a death-rate of 28.6 in each thousand 
inhabitants. 

Zymotic diseases destroyed in the aggregate 8,365 
lives — being 31 per cent, ot the total mortality — a slight 
increase upon 1870. The most prominent epidemic of 
the year was that of small-pox. This disease had pre- 
vailed to an unusual extent in 1870, having produced 
293 deaths, but it had so subsided in the autumn of 
that year, that in the three months ending December 
31st, 1870. it occasioned but 12 deaths. In the early 
part of January, 1871, it broke out afresh with extra- 
ordinary vigor, and rapidly increased during the en- 
suing six months. It caused 208 deaths in the first 
quarter of the year, and 304 in the second quarter. In 
the summer it began slowly to decline, its mortality 
being 164 for the quarter, and but 23 for the month of 
September. Up to that time the work of vaccination 
had been so energetically pursued by the vaccinating 
corps of the Health Department, that they had vacci- 
nated 100,000 persons in nine months. At the very 
time, however, when the prospect was most favorable 
for entirely arresting the disease, the Board of Health 
was obliged, on account of the failure of its pecuniary 
resources, to dispense with its extra inspectors for 
some two months. The result was soon apparent in 
the extension of the epidemic, as, although only 23 
deaths were due to small-pox in October, it occasioned 
36 in November, and 70 in December. On November 
21th the work of vaccination Avas resumed, but the 
disease had acquired too nmch new force to be readily 
overcome. Its total mortality for the year amounted to 
805, its greatest yearly niortality recorded in this city 
during the present century, the next largest number 
of deaths, 681, having occurred in 1853. During the 
year 2,085 cases were reported to the Bureau of Sani- 
tary Inspection. According to these figures its mor- 
tality reached 39 per cent. About 47 per cent, of the 
deaths were among children of 5 years old or less. 
The greatest number of deaths according to locality 



were as follows: 17tli Ward, 41; 22d Ward, 37; 
2()th Ward, 26; 21st Ward, 23. The Small-Pox Hcs- 
j)ital furnished 572. Its severity here during the past 
year, although remarkable for New York, was insigni- 
ficant as compared with its ravages in many other 
places throughout the world. We may simply mention, 
for example, among foreign cities the Hague and Lon- 
don. In the former (whose inhabitants have always 
evinced a peculiar antipathy towards vaccination) the 
mortality from small-pox during the first quarter of 
1871 was enormous, reaching the extraordinary annual 
death late of 48 in the thousand inhabitants — a rate 
which would have pioduced in New York 7,500 deaths 
from smnll-pox in three months. In London there 
were registered during the year 7,876 deaths from 
small-pox in a total from all causes of 80,332. In a 
single week the fatal cases amounted to 288. The 
same death-rate here would have given us 2,300 deaths 
instead of 805. The most remarkable epidemic of 
small-pox upon this side of the Atlantic has devastated 
the city of Philadelfihia. Nearly 2,000 fatal cases were 
registered during the past year, of which 1,^12 oc- 
curred in the three months ending December 31st. 
233 were recorded in a single week. 

The next zymotic disease which displayed ati un- 
usual activity here during the past year was whooping- 
cough. It carried ofi" 465 victims, being the greatest 
number of lives destroyed by this disease in any year 
of the present century, the next largest number having 
been 377 in 1855. 01' the 465 deaths, 196 were males 
and 269 females. The large preponderance of females 
over males is curious, but, as the death records of 
former years show, is quite characteristic of this aftec- 
tion. As far as we are aware it is unaccountable. 

Remittent fever during the year caused 165 deaths; 
intermittent, 110; and typho-malarial, 12. These fe- 
vers were never so fatal belore. They prevailed most 
extensively in the upper wards of the city. 

There is little of interest to record in regard to the 
other zymotic afiections. The following statement 
presents the mortality of the principal ones for the 
yearg 1870 and 1871: 

1870. 1871. 

Scarlatina 975 791 

Measles 298 409 

Diphtheria and croup 729 704 

Typhus fever 96 65 

Typhoid fever 422 239 

Diarrhceal diseases 3,956 3,653 

The principal feature of the above statement is a 
considerable falling ofi' during 1871 in the mortality 
from typhus and typhoid fevers and diarrhoeal com- 
plaints. 6 deaths were ascribed to cholera ; 6 to re- 
lapsing fever; 2 to yellow fever; 142 to sypliilis; 7 to 
hydrophobia, and 220 to intemperance. Typhus and 
tvphoid fevers Avere most prevalent and fatal in the 
l"7th Ward. 

The following cases of contagious disease y^ie re- 
ported to the Bureau of Sanitary Inspection during the 
year : 

Typhus fever, 126; typhoid fever, 492; scarlatina, 
2,850; relapsing fever, 80; measles, 1,626; diphtheria, 
408; small-pox, 2,085. 

Constitutional diseases produced 6,263 deaths, about 
23 per cent, of the whole, against 6,329 in 1870. Of 
these rheumatism caused 103 ; cancer, 339 ; marasmus 
and scrofula, 757 ; hydrocephalus and tubercular men- 
ingitis, 755; and phthisis pulmonalis, 4,186. The 
mortality fiom phthisis was equivalent to 15i per cent, 
of the total, and was both positively and relatively 
large as compared with that of late years. In 1866 it 



34 



THE MEDICAL RECORD. 



wa3 equal to 12.2 percent.; in 1867 to 14.4; in 1868 
to 13.7; in 1869 to 1:3.3; in 1870 to 14.8; and in 
1871 to 15.'). We thiKS [KTceive tliat tliis formidable 
disease has been constantly increa.sinf,' in falJilily during 
the past six Vi^'.^. About one-(iuait(T of its deatlis 
tooi< jdace in "hospitals, and a lar<,'e majority among the 
tcnomfnt-liouse population. The migratory character 
of that ela.ss of our inhabitants rcndersit almost impo.s- 
sible to observe and localize those regional causes 
-which may inlluence consumption in this city. 

Local diseases, or aflections of special organs, occa- 
sioned 9.282 deaths; 34 per cent, of the whole, a 
decrease of G17 from the previous year. Of these 
there were due to diseases of the nervous system, 
2,G77 deaths ; circulatory system, 894 ; respiratory 
system, 3,*J48; digestive system, 1,0')2 ; urinary sys- 
tem, 1,103; generative system, 54; locomotory and 
osseous system, 120 ; and integumentary, 74. Among 
these theVe was little worthy of extended mention. 
There were 904 deaths from bronchitis, and 1,834 from 
pneumonia, against 855 and 1,830 respectively in 
the preceding year. Urinary diseases were uncom- 
monly fatal, and they appear to have been becoming 
more" and more so during the past few years. Thus 
the deaths by Bright's disease within four years have 
been as follows?, commencing Avith 1808: 534; 557; 
787, and 947 — an increase of 77 per cent, during tlie 
period mentioned. 

Developmental diseases (or those arising from ab- 
normal action of the formative, reproductive, or nutri- 
tive processes) produced 1,703 deaths, or Oi per cent, 
of the whole. 888 were in infants newly bom ; 312 
in women ; 333 were due to senile decay ; and 230 to 
atrophy and asthenia. These figures were somewhat 
in excess over the previous year. 

Finally, the deaths from violent causes amounted to 
1,303, or 5 per cent, of the whole, against 1,000 in the 
jirevious year. " The increase was owing principally to 
the July riot, which caused 53 deaths, and the West- 
field explosion, 82. 1,070 deaths were ascribed to 
accident and negligence ; 05 to homicide; 114 to sui- 
cide ; and one was a judicial execution. 

Of the total number of deaths, 7,994 occurred among 
infants less than one year old ; 10,700 among those 
less than two years old ; and 12,970 among children 
less than five years old ; the last being 40 per cent. 9f 
the total mortality. In 1870, the deaths among such 
children were equal to 49 per cent, of the whole; in 
1809 to 51 per cent. ; in 1808 to 52i percent. ; and in 
1867 to 53 per cent. Altogether, therefore, between 
1867 and 1871, there has been a gain among children less 
than 5 years old of 13 per cent, upon the total mortality. 
There Avere 1,290 deaths among persons 70 years old 
and upwards, a gain of 74 upon the previous year. 14 
were reputed to have been 100 years old or more, of 
whom 3 were males and 11 female?. 
KespectfuUy submitted, 

Chas. p. Russel, M.D., 
Chairman Com. on Diseases. 

C.VNTUOPLASTY IX CONJUNCTIVAL AND CORNKAL AFFEC- 
TIONS. 

Dr. H. Althof read a paper entitled Clinical Notes 
on Diseases of Conjunctiva and Cornea. Its main object 
was to call attention to an important element, hitherto 
rather neglected in the therapeutics of these affections, 
viz. : the diminishing of the pressure of the lids upon 
the globe. After a review of the present methods of 
treating the more serious forms of conjunctival disorder 
— granular lids, diphtheria, blennorrho^a, etc. — all of 
them only partially under the control of the physician, 
Dr. A. entered more directly upon its special subject. 



Thus far, three diflferent procedures had been occa- 
sionally followed for the purpose of relieving the ball 
of the eye from excessive pressure, viz. : incisions or 
excisions of chcmotic conjunctiva; removal of a trian- 
gular piece of skin (down to the niu.scle) from the up- 
per lid ; and splitting of the outer angle. This last 
method undoubtedly suited best, but its goo<l effect 
was very transitory, the wound healing up in too short 
a time (a couple of hours) to give any i)ermanent re- 
lief. If, therefore, a way could hi; found to modify 
this remedy so as to make its results la.sting, the thera- 
peutic means at our disposal would receive a valuable 
addition. This Dr. Althof thought to have been found in 
the little operation known under the name of can- 
thnplastij. — the splitting of the external commissure 
down to the conjunctival .sac, and careful uniting of the 
conjunctiva to the outer integument. 

The results of this simple procedure had been very 
favorable, a large number of cases at present testifying 
to its cfliciency. It had rapidly become popular in our 
great infirmaries, and wa.s now, after five years' trial, 
con.sidered by American oculists a very welcome remedy 
in cases v/hich had bafiled the most skilful efi'orts, and 
in diseases against which the prevailing treatment was 
almost powerless. (jlranular lids and phlyctenular 
conjunctivitis and keratitis furni.shed the great majority 
of cases in whicii canthoplasty might be employed 
with aavantage — to cut olf acute attacks, to diminish 
the number of relapses, or prevent them altogether, 
and to give other remedies a better chance for effecting 
a perfect cure. In genuine diphtheria the doctor 
thought it almost inilispensable ; and blennorrhcx>a in 
its most acute and destructive forms lost most of its 
dangers. 

Dr.H. D. Notes agreed Avith Dr. Althof in his high 
estimate of the operation of canthoplasty. It had be- 
come as much a sine qva non in the treatment of tracho- 
ma as had iridectomy in that of glaucoma and diseases 
of the iris. 

The remarks upon diphtheritic conjunctivitis had 
especially interested him, from the fact that he had 
within three weeks had in his practice four cases of the 
affection, one them very severe, involving the ocular 
as well as the palpebral conjunctiva. Up to six months 
ago his experience had furnished him Avith but feAV 
examples of this disease. Since that time he had had 
perhaps a dozen ; and he believed the occurrence of 
these cases in such close succession was coincident 
Avith an unusual prevalence of scarlet-fcA'er and of 
croupous afiections generally. 

As to the therapeutics of conjunctival disorders, there 
was less need of discovering new means of treatment 
than of learning precision in the application of those 
now known ; for their number was already bewilder- 
ing. 

Dr. Agnew's experience had confirmed his belief in 
the bold use of canthoplasty. He had been led to 
modify the operation by division of the edge of the ex- 
ternal tarsal ligament of the upper lid only, as exposed 
in the Avound. It Avas the pressure of the tarsal carti- 
lage of the upper lid Avhich caused the chief trouble ; 
and the incision of skin and mucous membrane alone 
would not always make such pressure harmless. He 
felt confident that since the introduction of iridectomy 
no other addition so important as canthoplasty had 
been made to the resources of ophthalmic therapeutics. 

Dr. Edward Curtis could testify to the value of the 
procedure in phlyctenular conjunctivitis, the prompt- 
ness of its eflect seeming at times almost magical. He 
related a case, attended Avith great photophobia, cured 
by its means in a couple of days. 

Dr. E. H. Derby thought the advantage of the ope- 



THE MEDICAL RECORD. 



35 



ration lay, perhap?, as much in its enabling the surgeon 
to reach the retro-tarsal fold with his applications as 
in the relief from pressure it afforded. Von Graefe ob- 
jected to its employment in diphtheritic conjunctivitis, 
from the danger that any wound in such a case might 
itself become the seat of diphtheritic deposit. 

Dr. ALxnorhad had only seventeen cases of diphthe- 
ritic conjunctivitis in five years, up to September last, 
though since then he had seen at least twenty. He 
would not set his own slight experience against Ton 
Graefe's; but although he had always found the 
diphtheritic deposit infiltrating the incision, as it does 
wounds of other pai-ts, yet he regarded this as of 
slight consequence, when compared witii the great ad- 
vantage conferred by the operation. By the time the 
diphtheritic trouble was cured, the wound was well 
healed, and no harm had come of it. 

Dr. Koosa had never seen any grave consequences 
from the operation as performed by Dr. Althof, though 
he had several times seen ectropion of the lower lid 
follow, as a result, perhaps, of the incision having been 
made not horizon tall}'' outwards, but obliquely down- 
wards. He had known, however, one or two instances 
of serious injury from the operation, where the dissec- 
tion of the conjunctiva was made very thorough, and 
carried into the orbital tissue. In one case the eve was 
lost. 

Four years ago he had had a dispensary case of 
phlyctenular keratitis, relieved most remarkably, in 
twelve hours, by the operation. He was not aware at 
the time that it had been previously performed for this 
form of disease. 

Dr. Lorixg had been anticipated by the last speaker 
in most of what he was about to say. He had ob- 
served some half a dozen cases of ectropion due to the 
operation, and had several times seen trouble from too 
free a dissection of the parts. He thought the division of 
the external tarsal ligament, suggested by Dr. Agnew, 
should be limited to those cases in which trachoma had 
progressed to the extent of converting the inner surface 
of the lid into a hard, cicatricial tissue, which by its con- 
traction had warped the tarsal cartilnge, increasing its 
natural curvature, so as to bring its sharp edge against 
the cornea. He had himself formerly employed the 
method, originally proposed by Pagenstecher, of dissect- 
ing up the conjunctiva so as to make a considerable 
flap, the sides of which were so stitched to the skin 
near the outer extremity of the horizontal incision as to 
convert this into a wound, with its long diameter verti- 
cal. But this produced much greater deformity than 
the method followed by Dr. Althof; and moreover, as 
before remarked, the liberal incision into the orbit was 
by no means free from danger. He had seen two in- 
stances of severe inflammation from it, one of them be- 
ing that referred to by Dr. Roosa, in which the eye was 
destroyed. He had therefore abandoned the jilan in 
favor of the simple operation recommended in the 
paper. In this, as there stated, the stitch at the angle 
was the main point upon which success would de- 
pend. 

Dr. Agnew did not mean to say that he would cut 
the tarsal hgament in every case, or that he would ever 
cut it in the lower lid. But he would incise it oftener 
than recommended by Dr. Loring, on account of the 
danger of relapse when this was omitted. Indeed, he 
had more than once been obliged to divide the ligament 
by a secondary operation, where the ordinary horizon- 
tal incision, previously made by another surgeon, had 
proved insufficient. There was no difficult dissection 
required, and no danger of orbital cellulitis. It usually 
sufficed to make the incision through the edge of the 
ligament, near its insertion into the periosteum of the 



orbital rim. It need not be cut in such simple cases 
as those of phlyctenular ophthalmia with photophobia. 

CEREBRO-SPI>fAL MENINGITIS. 

Dr. RrssEL said that, within three days, seven cases 
of cerebro-spinal meningitis had occurred in the city, 
three of which had proved fatal. At the suggestion of 
Dr. Peters, he read the report of an interesting case 
furnished by Dr. C. E. Simmons. The Health Board 
were anxious to study the disease, and asked, as a 
matter of favor, an early report of any cases which 
might be discovered. 

The Presidext had seen two cases on the east side 
of the city, near Dr. Simmons' case, one of them in the 
Hebrew Orphan Asylum at Third avenue and Seventy- 
seventh street. He had also, by the invitation of Dr. 
Eodenstein, been three times to see the cases under his 
charge at the Catholic Protectory in Westchester. 
There were some twenty of them ; and five or six had 
ended fatally. The speaker pointed to the presence of 
stagnant water between Second and Third Avenues, in 
the upper part of the town, as connected with the 
prevalence of endemic diseases in that neighborhood. 

criminal abortion. 

On motion of Dr. S. Rogers, the Society 

Risolvech That the Medical Society of the Cotmty of 
Xew York indorses the Amendment to the Law of 1869, 
relative to criminal abortion, proposed by the Xew York 
Medico-Legal Society. 

Adjourned. 



Special Meetiny. January 29, 1872. 
Dr. a. Jacobi, President, in the Chair. 

OBITCARIES. 

The meeting was called to hear memorial notices of 
some deceased members, which had been prepared, 
under authority of the Comitia Minora, for transmission 
to the State Society. Dr. Fordyce Barker, to whom 
had been committed the notice of Dr. George T. EUiot. 
was unavoidably absent. Dr. Ellsworth Eliot gave an 
account of the life and labors of Dr. Wm. B. Bibbins ; 
and Dr. Wm. C. Roberts reviewed the career of Dr. 
Henry D. Bulkley. The leading points of these memo- 
rials have already appeared in our columns. Dr. David 
C. Carr recounted the professional and other services 
of Dr. Alexander N. Grunn, dwelling especially upon 
the assistance he had always been ready to profi'er to 
young men. As chairman of the committee on resolu- 
tions. Dr. Carr reported the following, which were 
adopted : — 

^yhereas, It has pleased an aU-^-ise Providence to re- 
move from his earthly labors Dr. Alexander X. Guxx, 
a beloved associate, and an honored member of the 3Iedi- 
cal Society of the County of Xew York ; 

Revolted, That in his death all have lost a valued friend 
and counsellor. 'and this Society one of its brightest orna- 
ments, distinguished alike for his eminent social qualities, 
his Christian virtues, and his professional ability. 

Rosohed, That while we bow in submission to the di- 
-N-ine will, we deplore the loss of an active worker in the 
profession to which he was an honor ; of a man who by 
his genial, snnshiny nature won not only the hearts of 
his patients, but the confidence and esteem of all who 
knew him. 

Resolved, That a copy of these resolutions be preserved 
in the archives of the Society, and also that a copy, 
signed by the President and Secretary, be sent to the 
family of the deceased. 

The meeting adjourned. 



36 



THE MEDICAL RECORD. 



A Special Meeting called for February 3d, " to con- 
Kiik'r, and t.iko suiUiblc action upon, llio bill recently 
intro lutrd into the Assembly by Mr. Klaiiuncr, enii- 
tli'il. An Act to Protect the People against Quackery and 
Crime," was very thinly attended, and adjourned with- 
out action. 



NEW YORK PATHOLOGICAL SOCIETY. 

Stated Meeting, January 10, 1872. 

Dr. a. L. Looms, President, in the Cliair. 

LATENCY OF STMPTO.MS IN EMPYEMA. 

Dr. Lewi.s Smith presented specimens of lunjrs remov- 
ed from infants dyinp in the Infant's and Child's Hos- 
pital of this Ciiy. The first specimen was taken from 
a little patient that died at the age of five months and 
twenty-eight days. Although in charge of one of the 
best nurses of the institution, nothing unusual was 
noticed about the child, except a slight hacking cough 
for two or three day.*, and some acceleration of the res- 
piration, until it was found dying. On post-mortem 
examination tlie right lung was found covered with a 
thick sero-fibrinous exudation. The serum, which was 
very considerable in amount, was confined altogether in 
the meshes of the fibrinous material. The case was of 
interest as showing the latency of the symptom.*. There 
wns no evidence to the naked eye of pus in the effu- 
sion, although it was probable that pus-globules could 
be found by the microscope. Dr. Smith was of the 
opinion that, in cases of pleurisy among foundlings in an 
hospital, pleurisy as a rule degenerated into empyema. 

tubercclosis following bronchial catarrh. 

The second specimen of lungs was removed from an 
infant aged four months and ten days. It had suffered 
I'rom cough for seven weeks, during -which time the 
physical signs of bronchitis bad been developed. Dur- 
ing the last week of life, in addition to the symptoms 
referred to, there was an expiratory moan, and this, 
with other phenomena, led to the diagnosis of cheesy 
pneumonia. Two or three days before death, evidences 
of a dilated bronchial tube or a cavity were very dis- 
tinctly made out. 

On making the post-mortem examination, the left 
lung was found healthy, with the exception of a col- 
lection of small miliary tubercles. These masses were 
also discovered scattered throughout the right lung, in 
which latter organ also was found a cavity the size of a 
filbert, and nearly filled with cheesy matter. This 
cavity was so near the surface that a local pleurltis was 
excited, which accounted for the respiratory moan 
heard during life. This cavity was lined by a pyogenic 
membrane. 

In addition, small tubercles, some scarcely visible, 
were found in the spleen, liver, and in the coats of the 
large intestine. The other organs were healthy, with 
the exception of some of the bronchial and mesenteric 
glands, which were slightly enlarged and contained 
cheesy deposits. The interest in this case centred in 
the regular gradation of pathological changes, commenc- 
ing in ordinary bronchitis and ending in miliary tuber- 
culosis. 

The third specimen was removed from a child that 
died at the age of three months. The patient was sup- 
po.sed to be doing well until eighteen hours before his 
death, when he began to breathe rapidly, the pulse 
became accelerated, the temperature elevated, and 
death finally occurred as the result of what was sup- 
posed to be capillary bronchitis. 



At the autopsy, both lungs were found studded with 
tubercles in process of formation, and around them 
were to be teen zones of vascular injection. Small 
tubercles were also found in spleen, liver, ami in other 
organs. The mc.M;ntcric glands appeared to be healthy, 
but the bronchial glands had ui;dergone cheesy de- 
generation. 

In answer to a question from Dr. Loomis, he stated 
that in his opinion empyema was more apt to follow 
pleurisy in foundlings tiian in adults. 

Dr. Loomis remarked that he had seen cases of acute 
pleuri.sy in adults, that were cases of empyema from the 
bcfiinning, and he had also .seen cases of empyema the 
natural residt, apparently, of ordinary pleun.sy in a pa- 
tient otherwise in good condition. 

The Society then went into Executive Session. 



Stated Meeting, Jan. 24, 1872. 
Dr. a. L. Loomis, President, in the Chair. 

uterine tumors and ascites. A NOVEL METHOD OF 

TAPPING. 

Dr. Caro presented a specimen of the above with 

the following remarks: Mrs. H , thirty-nine 

years old, married twenty years, had no children. She 
complained, November, 18G4, of dy.smenorrhoea. On ex- 
amination, a polypus the size of a cherry was found 
protruding from the internal os uteri. I evulsed it 
with a pair of long forceps, and cauterized the pedicle 
with nitrate of silver. No hemorrhage followed ; men- 
struation returned regularly until September, 18G8, 
when it disappeared. Supposing herself pregnant, 
she did not inform me of the loss of her catamenia un- 
til November of the same year. Examining the 
uterus, I found she was mistaken as to pregnancy, 
although her breasts gave evident signs of it. I advised 
no interference, but to wait for further developments. 
January 20th, 1869, called in consultation the late 
Prof 0. T. Elliott. We concluded she was not preg- 
nant, but could not decide upon what -prevented her 
monthly returns, or caused the abdominal enlargement, 
unless it was simple tympanitis. Nourishing diet was 
prescribed, and an occasional dose of cream tartar and 
Epsom salts to regulate the bowels. In February men- 
struation returned, and continued regular until death ; 
but the abdominal enlargement continued, giving signs 
of ascites. June 4th, 1869, had her examined in the 
presence of other physicians, at Dr. Emmet's hospital. 
As previously done, sound was passed into the womb, 
two and a half inches. Arrived at the conclusion that 
she had a fibrous tumor adhering to the womb, and 
ascites produced by subacute peritonitis. Elaterium 
and cream tartar were prescribed, also tapping. 

June 30th, in presence of Prof O. T. Elliott, I per- 
formed paracentesis, selecting the median line between 
umbilicus and pubes; — sixteen quarts of fluid were 
drawn. Microscopical analysis of the fluid was made 
by Dr. Stephen Rogers, who reports : " The fluid 
was highl}-- albuminous, contained many blood-globules, 
and amorphous colored constituents in the form of 
various-sized dark-brownish masses. There are also a 
few granular, cell-like objects, containing one or more 
nuclei, in fact exudation corpuscles." Suspecting them 
to proceed from a cystic cavity, I changed my treat- 
ment and prescribed: — 

Spiritus mindereri § iv. 

Acidum aceticum 3j. 

Tr. ferri ehloridi 3 ij. 

A tablespoon ful three times a day. 



THE Medical record. 



37 



This remedy increased the flow of urine, but did not 
arrest the ascites. She was tapped every second 
month as follows : August 30th, 1809, second tappinj?, 
twenty-one quarts were drawn ; October 26th, 18G9, 
third tappiiip-, twenty-three quarts were drawn; Janu- 
ary 4th, 1S70, fourth tapping, twenty-five quarts were 
drawn; March 19th, 1870, fifth tapping, twenty-four 
quarls w^ere drawn ; May 11th, 1870, sixth tapping, 
twenty-eight quarts were drawn ; July 9th, 1870, 
seventh tapping, twenty-eight quarts were drawn ; 
August 29tl), 1870, eighth tapping, twenty-seven quarts 
were drawn ; November 1st, 187U,ninth tapping, thirty- 
one quarts were drawn; December 15th, 1870, tenth 
tapping, thirty-two quarts were drawn ; February 10th, 
1871, eleventh tapping, thirty-six quarts were drawn; 
March 30th, 1871, twelfth tapping, at Emmet's hospi- 
tal, thirty-six quarts were drawn; May 27th, 1871, 
thirteenth tapping, twenty-six quarts were drawn. 

Left canula permanentl}', with a iaucet, so she might 
draw the fluid herself, but during tint night it came 
out. July 11th, 1871, fourteenth tapping, twenty- 
eight quarts v-^ere drawn, and canula lell in situ until 
December 10th, when it was removed to be repaired. 
After removal the flow of fluid stopped, and abdominal 
pains commenced. January 10th, 1872, she died of 
peritonitis. On post-mortem examination, a vast 
amount of fatty degeneration was found around the 
womb ; to the left fundus of the uterus, two ovarian 
cysts, about the size of a pine-apple, adhering to one 
another; and above them a tumor of calcareous nature, 
adhering firmly to the diaphragm, the abdominal vaults 
firmly adhering to the cysts and tumor, and the peri- 
ton£Eum to the intestines infiltrated with a serous fluid. 

The fluid from the cysts and the tumor were ex- 
amined by Dr. S. Rogers, who reports as follows : 
" The hard masses found in the substance of the speci- 
men are composed of irregularly spherical bodies, car- 
bonate of lime, adhering to each other very firn)h^ It 
is henc-i ca^.careous, not osseous. The tumor is a some- 
what degenerate fibroid growth. The fluid from an 
adjacent cyst is of a brownish color, and abounds in 
crystals of cholcsterine, fatty granules, and globules. 
It is therefore not improbable that the cyst represents 
a degenerate and liquefied fibroid tumor." 

The amount of fluid by paracentesis was 381 quarts, 
and drawing at an average one pint a day from July 
11 to December 10th, was seventy-six quarts, total 457 
quarts. Of the mixture, as above prescribed, 244 oz. 
was used. 

Dr. Hart referred to the possibiliiy of the tumor being 
cancerous, as, according to Prof. Thoma^^, the persistent 
accumulation of serum in the abdominal cavity was 
almost pathognom.onic of that disease. 

Dr. Loomis remembered one case where tapping was 
performed twenty-eight times. The patient, a lady, 
had been tapped twenty times by the late Prof Simp- 
son, of Edinburgh. The intervals of tapping grew 
longer, and the last operation was performed as long 
ago as four years. 

ANEURISM AND ITS RELATION TO SYPHILIS. 

Dr. Flint exhibited a specimen of aneurism of the 
abdominal aorta. The history of the case was very in- 
complete, the patient being received in the hospital 
only a few houis before his death, and then in a state 
of almost complete exhaustion. It Avas ascertained, 
however, that he had had syphilis fourteen years be- 
fore, followed by certain constitutional symptoms, af- 
fection of the throat, eruptions, etc. During last sum- 
mer he had complained of pain in the back and abdo- 
men. After his admission he rallied somewhat on tne 
use of stimulants, so that the facts above narrated were 



obtained. The hou.se physician ascertained the pre- 
sence of a tumor which he found to be pulsating, but he 
discovered neither thrill nor murmur. Shortly after 
his temporary improvement he raised up in bed, when 
he complained of feeling faint, was laid back, and ex- 
pired almost immediately. 

The abdominal aorta, just above the renal arteries, 
showed a large circular opening, perhaps an inch and a 
half in diameter, which communicated with an aneuris- 
mal sac the size of a small orange. There was a per- 
foration in the sac large enough to admit the end of the 
little finger. There was some blood infiltrated in the 
areolar tissue beneath the artery, and the peritoneal 
cavity contained a large quantity of blood. The speci- 
men was of no particular interest except the fact that 
it occurred in a patient who had syphilis, and that, in all 
probability, there was a certain amount of hemorrhage 
from rupture before he was admitted into the hospital, 
and that the hemorrhage was arrested by temporary 
coagulation. The internal coat of the artery was lined 
with atheromatous deposits. The patient was 37 years 
of age. 

SYPHILIS AND VALVULAR DISEASE. 

Dr. Janeway believed that syphilis was not only a 
very common cause of aneurism, but a'so of valvular 
disease. He had met with two cases of thickening of 
the valves which could be explained in no other way. 

Dr. Flint had not had his attention drawn particu- 
larly to syphilis as a cause of valvular disease, but 
thought that it might explain many of the cases of the 
latter le.sion, in which none of the usual causes were 
made out. 

Dr. Mason had seen several cases of aneurism which 
appeared to be the direct result of constitutional syphi- 
lis. He referred to one case in point, occurring in a 
man aged 33. 

Dr. Loomis alluded to a long list of cases published 
within the last two years in the Lancet, in which all 
under the age of forty gave a syphilitic history. 

Dr. Rogers was reminded of a case presented to the 
Society ten years ago, of very extensive aortic disease, 
in a young man 28 years of age, who had contracted 
syphilis only eighteen months before his death. The 
patient eventually died of extensive aortic disease. In 
that case no other cause for the arterial and cardiac le- 
sions was assigned than syphilis. 

PERIPHERAL PLACENTITIS. 

Dr. Rogers presented a foetus, with the following re- 
marks : — About a month ago I presented a specimen of 
placental disease that has been ranked as comparatively 
rare. Its history was. that a lady, at about the begin- 
ning of the fifth month, or a Httle after, began to sutler 
from the escape of blood from the vagina, with uterine 
contractions which were regarded, by every one who 
saw her, as threatening abortion. The bloody charac- 
ter of the discharge subsided little by little; but at va- 
rious intervals she had very large discharges of colored 
fluid, in such abundance as to saturate six or eight nap- 
kins in a single evening. In that case there were also, 
within a period of twomouths, after frequent threaten- 
ings of abortion, contractions of the uterus, with the es- 
cape of more or less bloody fluid. So marked were 
these contractions that the lady herself would call at- 
tention to it. There was a good deal of interest at- 
tached to the case, and some of the leading obstetri- 
cians were called in to see it. It was regarded as a case 
of cystic degeneration of the ovum. However, from 
time' to time, besides bloody fluid there Avas a discharge 
of such a material as is seen in this vial. [A vial ex- 
hibited, containing blood-stained shreddy material, 



38 



THE MEDICAL Re);ORD. 



lloatinp in a bloody fluid.] Sometimes a plug of this 
material, as large as the little finger, would come away. 
Notwitlistaiidinjr the ca^e was (liaprnoslicatrtl as a cys- 
tic degeiuration of the chorion, tliere w.is evidently a 
live fcetus in the womb. It went on growing', and 
continued active up to the last. It was early in the 
fourtli iiioiilh that the t^ymploms commenced. Towards 
the end of the fifth month labor came on, and when I 
arrived I found the caput succedaneum protnidinp, and 
soon delivered the woman of a child which breathed an 
hour after birth. 

The placenta was found diseased ; its whole periphe- 
ry was blackened and slircddy. In some portions of the 
organ it had gone on to an extent of llirec-fourths to 
an indi in dc|)th. It was a striking example of a dis- 
ease of the whole peripliery of the placenta. It struck 
me at onre as a case of peripheral disease the like of 
which I had never .seen. I recited the appearances to 
Dr. Noepgerath, and he made the remark that the case 
was one of peripheral placentitis. 

I present another specimen very similar to the one 
just described. This case had advanced to the sixth 
month. The mother received a sliock, caused by one of 
her children running again&t her abdomen. Scon after 
she was taken ■with a discharge of blood from tlie vagi- 
na. There were no uterine contractions nor pain. All 
that was noticed for a few days was a little bloody dis- 
charge, when it became less blood}'. But at vari('US 
intervals she would have these large discharges blood- 
stained, which would saturate half a dozen napkins at a 
time. She went on for two whole months, and when 
labor set in the child was evidently alive. The presen- 
tation was a breech one, and the head of the child was 
detained so long that life was destroyed — at least 
such was the belief of the attendant. At all events, 
the child was alive two hours before labor set in. The 
placenta presentij a little different appearance from 
the first; it is much smaller, and its whole structure is 
lobulated. When this specimen was first "brought to 
me I found evidences over more tlian three-fourths of 
its periphery of this same kind of inflammation — peri- 
pheral placentitis. At two or three points there were 
little clots of blood, but the marked feature was a layer 
of fibrinous material — thicker at some places than 
others — all aroimd the edge of the placenta. Dr. Jacobi 
was disposed to look upon the fibrinous clots as the 
residue of the hemorrhages. That may be so, but in the 
case which I presented, during one period of more than 
two weeks, there was scarcely any hemorrhage; it was 
almost pure water, and on some occasions there were 
those extra fibrinous clot«, and during that period 
she had more discharge of those fibrinous shreds 
than she had immediately after, or about the time 
when there had been mo.st hemorrhage. They ran 
through a period of more than a month. 

I have since asked some questions of persons versed 
in the literature of the subject with reference to the 
frequency of this kind of placental disease, and I am 
precisely where I was a month ago, viz., that there is 
not very much written or said about it in that form. 
Dr. Noeggerath said then that the only paper written on 
this suViject was by Braun, of Vienna, several years 
ago. The first case, presented a month ago, has had no 
untoward symf.tom, and is perfectly well. The first 
.ady was delivered two years ago of a child that re- 
mained in utero a month after it died. The child was 
Killed at the eighth month by metro-peritonitis, which 
interrupted the foetal circulation. The mother in a 
measure recovered, and went on to full term. She had 
metritis after delivery, and a little pelvic cellulitis. 
She therefore had the antecedent of uterine inflamma- 
tion estabhshed, which this person has not. 



Dr. Jankwat thought that there might have been 
a partial deiachmoiitof the placenta in this la.st case, at- 
tended first with a disiharg'Mjf bl()0<i, tiicn serum with 
the shreddy material — the re^ulL of the breaking down 
of the dot. 

Dr. IlouEKS thought that this was the case in both 
instances. 

FUACTURE OF SKCTIX. 

Dii. J ANEW A V presented a specimen of fracture of 
skull, with the following history : — 

The patient from whom this .^^pecimcn was taken was 
a female lorly years of age, who, as subsequently to 
examination, was found to have been struck in the 
head by a hatchet, .some five years before. She was 
admitted to hospital tlie day before death, para- 
lyzed on the right side, and unable to give any 
account of herself. Later it was found that she had 
fallen down-stairs. She died with .symptoms of com- 
pression of brain. Sfrvice of Dr. Smith. 

Autopsy, Dec. 'J.3, 1871. 

Exterior. — Large amount of adipo.«e tissue. A .slight 
white cicatrix over the upper and middle portion of the 
right parietal bone. Some bruises on forearms. 

Scalp. — Extravasated blood in the tissues of left side 
posterior part, and a lacerated wound behind ear. 

Skull. — A fissure on left side, starting from centre of 
occipital bone, passes forwards through line of lamb- 
doidal suture, petrous portion of temporal bone, into 
larger wing of sphenoid bone, as far as foramen rotun- 
dum. The middle meningeal shows a small lacerated 
opening in its main branch. 

A large clot exists between dura mater and bone, 
principally situated over posterior lobe of cerebrum, 
outer and lower part of loft side. 

On the right side of skull, corresponding to the line of 
cicatrix above mentioned, a depression of outer table of 
skull is found, oval in shape, and situated diagonally 
between coronal and sagittal sutures. The border of the 
depression is rounded, smooth, and it and the depressed 
portion are lined by thickened periosteum. The depth 
of depression is 3-20 of an inch ; length 1 inch. On 
the inner side of skull, at this point, the internal table 
forms a sort of wedge-shaped projection, 1-5 of an inch 
high, and having a line of fracture running along the 
ridge or apex. This latter portion is still quite sharp. 
The dura mater at this point presents a similar shaped 
depression, but no other lesion. 

Brain. — There is a depression of brain on the right 
side, corresponding to site of depressed fracture, but 
without other lesion. A vein going to longitudinal 
sinus is pressed on, and the result has been a varicose 
condition on the distal side. On the anterior portion 
of brain, right side, the convolutions are flattened, sulci 
somewhat obliterated, and subarachnoid serum absent. 
The left side showed a severe contusion of lower part 
of left middle lobe, and extending across fissure of 
Sylvius so as to implicate the extremit}' of the third 
frontal convolution. The tissue at this point is softened 
to a pulpy state,'and ecchymotic cervical convolutions of 
frontal lobe were in a similar state. The brain-tissue of 
posterior lobe presented a depression corresponding to 
the site of clot of blood between dura mater and brain. 
The ventricles contained the usual amount of serum, 
slightly blood-stained. 

The other viscera, with the exception of kidneys, 
were normal. 

These latter presented a granular surface and atro- 
phied cortex, and were smaller than usual. 

The depression in this case led to the question of the 
propriety of an operation. \ 

But Dr. Stephen Smith, the visiting surgeon, decided 



THE MEDICAL RECORD. 



39 



against the propriety, because of the marks of injury 
behind left ear and of the paral3'sis on the right side. 
I have thouglit that the coincidence of tlie two lesions 
would be of some interest. 

PSEUDO-TRACIIEO-BRONCIIITIS. 

Dr. Lewis Smith presented a specimen of p.'eudo- 
tracheo-bronchitis, which was removed from a Avoman 
twenty-four years of nge. .She was admitted into the 
lying-in wards connected with the Nursery and Cliild's 
Hospital in Nov. last. Nothing unusual was noticed 
in her condition until the third of the present month, 
when the house-physician, Dr. Eeckwith, found her 
urine albuminous. Jan. 9 she called his attention to 
her throat, but on examination nothing worthy of note 
was discovered. On the third day after she began to 
sufler considerably from d3^spnoea, which condition in- 
creased so mucli in severity that by the thirteenth she 
was unable to lie in bed. At the same time a dry 
cough developed, and the physical signs of oedema of 
the lungs showed themselves. Death occurred two days 
after. As no other signs showed themselves, it was 
thought probable that death had been due either to 
oedema of the lungs or to oedema glottidis. 

On post-mortem examination, the following day, a 
pseudo-membrane covering the lower part of the epi- 
glottis, trachea, and bronchial tubes to their third divi- 
sion was discovered ; the membrane growing thinner 
as it went downwards. The underlying mucous mem- 
brane was intensely injected. 

The fauces had been inspected every day until with- 
in twenty-four hours of her death, and no appearance 
of membrane was noted. On careful examination at 
the autopsy it Avas discovered that the membrane had 
just begun to make its appearance upon the pharyn- 
geal surface of the epiglottis, Avhich condition might 
have been observed had an examination of the parts 
been made within ten or twelve hours of death. There 
were found large clots in all the heart cavities, which 
Avere much dilated. Those in the right ventricle extend- 
ed through the pulmonary artery to the lungs. The 
appearance of the membrane, its symptomatology, and 
the surrounding circumstances of the patient seemed to 
justify the opinion that this ease was one of true croup 
rather than of diphtheria, which fact made the speci- 
men interesting, occurring, as it did, in a person of that 
age. 

Dr. Janeaa'ay referred to a case illustrating the rapid- 
ity Avith Avhich oedema of the lungs can shoAV itself in 
cases of arrest of respiration. The patient Avas choked 
while eating his dinner in one of the wards of Belle- 
vue ; relief was obtained by immediate tracheotomy, and 
nothing was found in the air-passages, as far as any ex- 
ploration could be made. In five minutes from the 
time of the accident the patient died of secondary oede- 
ma of the lungs. 

Dr. Loomis presented a specimen, rather as a matter 
of curiosity than otherAvise. The history of the patient 
from AA^hom it was removed Avas very incomplete. She 
Avas forty years of age, and Avas admitted into Belle- 
vue on the llth of Dec. in a very exhausted condition. 
About a AA'eek before admission she suffered from in- 
tense pain in the right hypogastric region, which 
extended into the iliac region. About tAvo days after 
this pain made its appearance she began to vornit, and 
had diarrhoea. The vomiting and diarrhoea continued up 
to the time of her admission. She had had a similar 
attack about a year before, from Avhich she recovered 
after a lingering illness. The hou-se-physician noticed 
that there Avas a verj- offensive discharge from her va- 
gina, and in making an examination he found that the 
finger could not enter more than an inch, Avhen it Avas 



arrested by a mass of roughened tissue. lie regarded 
it as a case of cancer, and did not make a very tho- 
rough investigation of the exact condition of tilings at 
that time. Her abdomen Avas quite tympanitic, and 
soon after admission ?he sank into collapse. 

At the autopsy there Avere evidences of extensive 
peritonitis. In the right side of pelvic cavity there Avas 
an increased amount of connective tissue, and the 
broad ligament Avas thickened and hardened. There 
was an abscess at the rim of the pelvis, and it seemed 
as though another had broken into the pelvic cavity. 
All the tissues in the neighborhood had been thickened 
and indurated ; the bladder Avas pressed forward, and 
rectum flattened and adherent to the posterior Avail of 
the uterus. Tlic uterus itself seemed somcAvhat en- 
larged. 

The interesting point was that on opening the 
vagina a spool, an inch and a half in lengtli and three- 
quarters of an inch in thickness, Avas found in its cav- 
ity. Through the canal of this spool Avas a thread, 
knotted at its upper end. The loAver portion of the 
tube Avas covered Avith calcareous incrustations. This 
foreign body, Avhich had doubtless remained in its posi- 
tion for a considerable time, had ulcerated into the 
bladder, and had given rise to all the pathological 
changes in the pelvic cavity, ending secondarily in the 
peritonitis Avhich caused death. 

The Society then went into Executive Session. 



Cotres^JontrciTCf. 



LESSONS FROM SANDRINGHAM. 

To THE Editor of the Medical Record. 

Sir : — It is not often that the management of any 
medical case assumes the proportions of a public event. 
When it does, besides the interest of the masses, and the 
reputation of the attending physicians, there are at stake 
the general standing of the profession, and the rank 
then assignable to physic among the phj'sical sciences. 
The case of the Prince of Wales was of this class. 

In order to avoid even the appearance of being in- 
fluenced by popular and contradictory clamors in a 
question whose scientific interest is hardly second to 
the political, Ave have postponed the expression of some 
of the remarks suggested by tlie character of the bulle- 
tins of the physicians Avho attended to this memorable 
case. But now that the public has rendered its ordi- 
nary verdict: "All is Avell that ends Avell," let us say 
that all that came from Sandringham Avas not as Avell 
as it could have been for the eminent physicians them- 
selves, nor for the profession at large, nor for the fair 
name and promotion of medical science. 

We particularly refer to the sanitary bulletins as not 
representing accurately the condition of the patient, as 
virtually and Avrongfully ignoring the new means of 
clinical description Avhose A'eracity cannot be impugned, 
and as made up of the flabby expressions of alternate 
fears and hopes. 

We have simply heard that the Prince Avas better, 
Avorse, recovering, sinking, rallying, convalescing, re- 
lapsing, and finally recovering. For many Aveeks this 
was all the ncAvs given to an attentive world. The 
prognosis Avas as wavering, and seemingly as uncertain, 
as it might have been half a century ago, before ther- 
mometry or sphygmography Avas dreamt of Naturallj', 
these bulletins, very much resembling those issued 
from Metz Avhen France had the misfortune of not 
losing Louis XV., alias le bien-aime, were soon dis- 



40 



THE MEDICAL RECORD. 



trusted, nml nccii«cd of cxapgeration, oven of false- 
hood ; fttnl openly said to be calculated in view of 
manufacturiu!:!; loyalism, or for the vile object of fostering 
gambling conibinations. 

That men like Dra. Jenner, Gull, and Lowe, whose 
scientific reputation is so high, could have exposed 
themselves, and tlic medical profession as a body, 
to such inipos-ibic imputations, shows that there was 
n serious misconception of their duties to the sceince 
of mediiine, and tliat at a time when they had the 
whole civiliztMl world for an audience. 

It seems that tiie cause of their mistake was the idea 
that the majesty of the subject precluded the ]>ossibility 
of nublishinn the true clinical record of his sicknes.s, as 
if ine disease sliould behave differently in a Prince than 
in a simple hospital patient. This courtly idea offers 
the only extenuation for tiie unscientific character of 
these bulletin?, but is far from finding its justification 
even in courtly habits and traditions. For these tra- 
ditions and habits have always been, in case of sick- 
ness of a Queen. King, or Crown -Prince, to issue bul- 
letins as complete as the science of the time could 
afford, and to keep the royal patient constantly in view 
of .some of the high officers of State. 

And why that publicity of sickness and death; 
why cannot a king agonize quietly ; Avhy must peoples 
prey upon his decomposing form by minute reports 
and by de visii proxies ? Evidently because a prince 
— whatever could otherwise be his individual worth — 
is a cipher, wliose social value is borrowed from the 
millions standing by him, millions who have never 
been denied the right to know what becomes of the 
zero. 

Therefore we do not hesitate to affirm that, if the 
physicians of the Prince of Wales in issuing their 
bulletins hare literally conformed them.selves to courtly 
traditions, in avoiding or neglecting to stamp these 
bulletins with the seal of modern positivism, they have 
forfeited the confidence of the English nation; they 
have left the door of their council-chamber open to 
imtrue but deserved .suspicions; they have neglected a 
solemn occasion of impressing the people with the 
precision of the methods of observation which have 
been substituted for guessing at the bedside ; and 
thereby these eminent physicians have, in no small 
degree, lowered, or at least prevented the legitimate 
rise of, the standard of physic in public estimation. 

On the contrary, let us for an instant suppose that 
these eminent men. improving the opportunity actu- 
ally offered to them by the tradition of all the courts 
of Europe, would have clothed their bulletins in the 
scientific form adopted by the medical institutions of 
London, Pari?, Vienna, Berlin. New York ; these daily 
or hourly reports would have been written in a few 
figures, and summed up every septenary. They could 
also have been accompanied by a few commentaries, such 
as escape from the lips of a medical man looking at 
the table of vital signs appended to the bed of an ordi- 
nary subject of typhoid fever. 

In the supposition tliat these popular and progres- 
sive views had prevailed in the judgment of the physi- 
cians in charge at Sandringham, the world would have 
assisted to a novel and dramatic spectacle. We do not 
mean the spectacle of the pitiable youth slowly eaten 
up, then let go by the ulceration of his Peyer's 
glands — we mean the narration, by telegrams, of the 
phases of an almost typical case of complicated typhoid 
fever. Never before would nations have listened to 
such a tale, rna'nly told in advance, like a prophecy, 
by the thermometer ; never such interest would have 
been attached to predictions of better or worse, fore- 
shadowed on the stem of the instrument, and to the 



degrees of vitality infused in the patient by tonics or 
food, and written in tlie pulse-wave of the sphygmo- 
graj)h. Such a medical problem would never before 
have been solved to a larger or more interested 
audience: no better opportunity <'ould have been 
found to prove to the civilized world huw much of a 
science medicine has cume to be. 

If this mode of bulletins had been adopted — and we 
firmly believe that Aitken, Sydney Ringer, Wunder- 
lich, or Jaccoud would have carried it <jut — what an 
impulse would that lesson on positive diagnosis have 
given to the profession ; how higher would physio have 
instantly ranked in the c=timation of the public ; and, 
to speak but once like courtiers, what a chance the 
Prince would not have lost of being as useful and cele- 
brated for his sickness as his father was for his good- 
ness ! These are some of the iessons we had, and had 
not, from Sandringham. E. S. 

New York, Feb. 20, \b~-i. 



CLAY-DRESSIXGS FOR VARIOLA. 

To THE Editor of the Medical Record. 

Sir — During the recent epidemic I used clay-dressings 
for two pretty decided cases of confluent small-pox. 
Both patients were young women. One, a married lady, 
a;t. 23 /delivered on the second day of a six months' foe- 
tus), made a fair recovery, took cold after getting up, 
and in a few days died suddenly of empyema and peri- 
carditis; diagnosis confirmed by autopsy. Tiie other, 
single, ajt. 21, had the disease with great violence, re- 
covered rapidly, and is now well. In each case I dust- 
est finely-sifted pipe-clay over the face as soon as the 
pustules became fairly developed. This formed imme- 
diately a clean, dry, wholesome scab; abolished the in- 
tolerable itching and burning ; served apparently as a 
good absorbent of infectious material; and scaled off 
during convalescence, leaving underneath a sofr, natural 
integument. 

There was no disfigurement in either case. 

E. S. BC.NKER, M.D. 

Brookltk, Fob. 12, 1ST2. 



MEMBRANOUS CAST OF VAGINA. 

To THE Editor of the Medical IIecord. 

In your issue of January 15th, p. 512, appears a very 
interesting communication fio:n Dr. G. H. Miner, in 
which he describes a membranous cast of the vagina, 
expelled by one of hi-; patients. I have never seen a 
like example, but if Dr. Miner will read the last page 
of the ninth chapter of Montgomery' '" On the Signs 
and Symptoms of Pregnancy," I think he will find a 
very satisfactory explanation of these curious forma- 
tions. 

Dr. Montjromery attributes them to the coagulation 
and condensation of the epitlielium and mucus of the 
vagina by injections of nitrate of silver, and Dr. Miner 
had used in his case "a very strong solution — 3j. to 
3J. of water." 

Wm. Goodell, M.D. 

I'RESTOS IlETREAT, Philadelphia. 



The Darwinian Thkory. — The ]Viener ^fed. Pj-esse 
contains a singular argument in favor of the doctrine of 
Darwin, that man has developed from an ape. It is 
found in Brazil that the ape is equally susceptible with 
man to the ravages of yellow-fever, all other animals 
enjoying an immunity from the attacks of this disease. 



THE MEDICAL RECORD. 



41 



©bituarji. 



PROF. CHARLES A. LEE, M.D.. 

I'EEKSKILL, N. Y. 

Our old friend, Prof. Charles A. Lee, is no more. lie 
died February 14, 1872, at his home in Peekskill. It 
is safe to say tliat no one medical man has contributed 
more largely to the literature of his profession than 
he has. From early life to an advanced ai^e his pen 
has been busy in many departments of the healing 
art, and by dint of great industry and appHcation he 
soon won for himself the very enviable reputation of a 
learned writer. Nor did his powers of composition, or 
his ability to think deeply, forsake him in the latter days 
of his career. It would be impossible to give more 
than an epitome of his literary labors, extending as they 
did over nearly half a century. He has edited Lees 
Physiology, a work formerly in extensive use in our 
schools ; Elements of Geology, Copeland's Medical Dic- 
tionary, Pereira on Food and Diet, and many other 
works. He was for many years Professor in the New 
York University, the Bowdoin Medical College, Berk- 
shire Medical Scliool, the Medical School at Woodstock, 
Vt., Greneva Medical College, and was also one of the 
founders of the Buflalo Medical School. In connection 
with the late Dr. Stewart, of this city, he, many years 
since, estabhshed the Northern Dispensary, an institu- 
tion Avhich has been of great and incalculable benefit to 
the poor of New York. He was for many years editor 
of the New York Journcd of Medicine. During the 
years 18G0 and 18G1 he made an extensive tour of 
Europe for the purpose of ascertaining the accepted 
methods of treating the insane. He visited all the noted 
Insane Asylums abroad, and gave the results of his la- 
bors in an extended series of carefully written letters to 
the American Medical Times. From that time he became 
much interested in the study of psychology, and was 
soon enabled by his writings in the various periodicals 
of the country to establish the reputation of an autho- 
rity on mental diseases. He was not unfrequently 
called upon as an expert to testify upon important crim- 
inal cases, and his opinions, often elaborately Avritten, 
received the warm commendations of the presiding 
judges. He has been a frequent and esteemed contri- 
butor to tlie columus of this journal, and has always 
been ready and willing to give us that counsel which 
was the offspring of a sound judgment and of a consci- 
entious regard for strict justice. 

During the recent war his services were tendered to 
the Sanitary Commissioner, and as an inspector he ren- 
dered invaluable aiJ. If we were to enumerate his la- 
bors as member of the many Committees of the Ame- 
rican Medical Association of the State and pharmaceu- 
tical societies, w^e might fill pages; suffice it to say, 
however, that in the capacity of a worker in such avo- 
cations he was untiringly devoted to the best interests 
of his profession and to the surest means of advancing 
our art. in. the cause of medical education he was a 
faithful exponent of the views of the rising generation, 
and was never backward in expressing his opinion in 
an unmistakaljly radical manner. During the past two 
years he has been compelled, on account of declining 
health, to withdraw himself somewhat from the occu- 
pations he so dearly loved. Among other things he 
resigned his professorship at the Buffalo Medical School, 
of which, as has been before stated, he was one of the 
founders. 

He was a zealous churchman, and his spare time was 
devoted, in a quiet and unostentatious manner, to the 



support of Christianity. He lived the life of a consistent 
Christian, and in his walk and conversation, from his 
youth until the close of his earthly career, he proved the 
excellence of his spiritual choice. As a man he was 
upright in all his dealings, radical in his views, and an 
uncompromising enemy to fraud in any shape. Quiet 
in his demeanor, affable in manner, and earnest in spirit, 
he won for himself a large number of friends, who will 
unite with us in dropping the tear of affection upon his 
honored grave. 



ARMY NEWS. 

Official List of Changes of Stations and Duties of Offi- 
cers of the' Me'lical Department, U. S. Army, from 
February 5, 1872, to February 18, 1872, inclusive. 

Mills, Madison, Surgeon. — By S. 0. 30, War De- 
partment, A. G. O., February 5, 1872, granted leave of 
absence for sixty days. 

Frantz, Jno. H., Surgeon.— By S. 0. 38, War De- 
partment, A. Gr. 0., February 14, 1872, to report to the 
Commanding General, Department of the South, for 
assignment to duty. 

Mackin, Ciias., Jr., Assistant Surgeon. — By S. 0. 33, 
War Department, A. G. 0., February 8, 1«72, to re- 
port to the Commanding General. Department of the 
South, for assignment to duty. 

HoFF, Alexander H., Assistant Surgeon. — By S. O. 
31, War Department, A. G. O., February 6, 1872, 
as^igned to duty at Fort Columbus, N. Y. Harbor. 

Kimball, J. P., Assistant Surgeon. — By S. 0. 33, 
War Department, A. G. 0., February 8, 1872, assigned 
to temporary duty at Fort Columbus, N. Y. Harbor, to 
accompany the first detachment of recruits to New 
Orleans, La., and, on arrival, report to the Command- 
ing Officer, Department of the Gulf, for assignment to 
duty. 

LoRiNG, L. Y., As-istant Surgeon.— By S. 0. 18, 
Department of the Mo., February 2, 1872, to proceed 
to ifort Leavenworth, Ks., and report to the Com- 
manding OtKcer for assignment to duty. 



iJletiical Jtcms anti Hews. 



Marri.ige v. Celibacy. — M. Bertillon read a paper 
at the sitting of the Academy of Medicine of Paris, 
on the 14th of November, entitled '• Influence du 
marriage sitr la duree de la vie et stir les maladies 
intellectuelles on morales," maintaining the healtliful 
influence of conjugal association as compared with 
that of celibacy, and using as evidence the statistics 
of France, Holland, and Belgium. According to his 
figures, between the ages of twenty- five and thirty 
years 1,000 married men furnish G deaths; 1,000 
bachelors, 10 deaths; and 1,000 widowers, 22 deaths. 
From thirty to thirty-five years of age, the same classes, 
respectively, furnish 7, 11, and 17i deaths. From 
thirty-five to forty years of age the mortality is 7i, 13, 
and 17i per 1,000 respectively. And so on in a series 
of table's for all ages, the married man has always the 
advantage of the single man ; but what is the explana- 
tion of the fact that among widowers the mortality is 
even greater than among bachelors? In the case of 
men married under the age of twenty, the statistics 
show anything but a salutary result. Out of 8,000 of 



42 



THE MEDCCAL RECORD. 



this clas?, the mortality was, bi'fore mnrria<r«', only 7 
per 1,000 ; after ntarruKje it wng 50. This is a constant 
result in Paris, ]k'l;.'iuin. ami Ilollaml. Everywhere 
young mairii'tl ju-oplf, IVoni ciplit^-cii to twenty years 
of ape, die as fast as old people of from sixty lo seventy 
year/< of ape. Tiic conclusion seems evident, according 
to Ilufeland, " that the premature use of the genital 
organs i-; the most sure means of inoculating old age." 
This astonishing mortality being due to no special 
malady, but to a general enervation, which, witliout 
doubt, renders tlienj a prey to any disease. 

The same advantage of the marriage state obtains in 
the casr; of females, though up to the age of thirty the 
ditTerence is not .<;o apparent as in the other sex. From 
thirty lo thirty-five the morlalitv is 11 per 1,0U<» for sin- 
gle women, a:id only 9 [)er l.OOd for married women, and 
this difference increases up to the age of fifty-live. Thus, 
from fifiy to fifiy-fivc years t)f age 1,000 wives furnish 
only 15 or IG deaths, vvliilst as many single women or 
widows furnish 2G or 27. This advantage remains 
very notable beyond that age, diminishing but little. 
In France, however, under twenty-five, and in Paris, 
under twenty years of age, marriage is far from favor- 
able, but even injurious, as in the case of males. The 
mortality of unmarried girls of from fifteen to twenty 
is 7.53 per 1,000 ; the mortality of wives of tlie same 
age^being 11.86. The mortality of girls from twenty 
to twenty-five is 8.32 ; of wives of the same age, 9.92; 
the difference in this class being due, no doubt, to preg- 
nancy and its accidents. The deadly effects of widow- 
erhood in men is equally shown in the case of widows 
up to the age of tliirty, and after forty-five more single 
women than widows die. 

The influence of marriage on criminality is not le.^s 
striking. Whilst the crimin.'^lity of single men for 
crimes against the person is 100, in married men it is 
only 49, and 45 for offences against property. The 
criminality of widows and widowers approaches that 
of celibacy. Relative to suicide, the author concludes 
that this cause of death is reduced one-half by mar- 
riage. 

Chair of Physiology ix the University of Paris. — 
MM. Bt?clard and Yulpian are candidates for the afeve 
position, left vacant by the death of Longet. 

Is Insanity on the Increase ? — Dr. Henry Maudsley, 
writing on this subject in the British Med. Journal, says: 
"It may hd true, and probably is true, that there is 
more insanity, and more occurring insanity, in propor- 
tion to the population now, than at the time when our 
forefathers followed Boadicea to the battle; but that so 
many more persons should be yearly going mad now 
than twent3'-five years ago, seems tj me a supposition 
which is, I will not say preposterous, but is certainly 
not probable in itself, and not supported by facts. 
There is abundant evidence of a gradually improved 
registration of insanity, and of a great increase in the 
returns in consequence of that improvement, but there 
is not yet satisfactory evidence of anything more." 
''Some part of the difference," he says, '' is owing to 
the fact that certain patients are registered as lunatics 
now who would never have been thought so in times 
past." Also. '• a lower rate of mortality and a lower 
percentage of recoveries may account for an increase in 
the total amount of insanity." 

Conjugal Onanism. — In an important clinical lecture 
on " Conjugal Onanism and Kindred Sins," by William 
Goodell, M.D., Clinical Lecturer on the Di.seases of 
Women and Cliildren,University of Pennsylvania (T'/oTtf. 
2fed. Times), the resulting disorders from imperfect 
se.vual congress, on the part of man and wife, are plainly 



discussed. lie says the hu.sband suffers mentally, 
because no inan can behave in so unmanly a way witi - 
out a keen sense of self-abasement, without being stung 
by the chastisement of remorse. The wife suffers the 
most, because she both sins and is i-inned against. She 
sins, becau.se .she shirks tho.se responsibilities for which 
she was created. She is sinned against, because she is 
defrauded of her rights. The excessive stimulation 
of the whole rt'productive ap[)aratus remains unap- 
pea.sed. Excessive coitus, even when normally per- 
formed, and especially indulged in during the fatigue 
and discomforts of the honey-moon journey, .so often 
the starting-point of uterine disease, with the disorders 
resulting therefrom, were alluded to. 

Such papers are especially needed at the present 
time, as some members of prominent societies, like the 
'•London Dialectical Society," have been earnestly ad- 
vocating plausible arguments against " Over-Population 
and Large Families." 

Excision of the Elbow-Joint. — John Reddy, M.D., 
Physician to Montreal General Hospital (Canada Afed. 
Journal), relates a favorable case of excision of the right 
elbow-joint, for caries in a patient aged seventy-two 
years. The olecranon was first removed, then the arti- 
culating ends of the radius and ulna, to the extent of 
about three-quarters of an inch, and lastly, about an inch 
of the end of the humerus. Six months subsequent to 
the operation, the patient enjoyed a tolerably fair use 
of the arm, complete flexion being the most deficient 
movement. Dr. Reddy considers this case establishes 
the fact that advanced age does not prove so great & 
barrier as is generally supposed to excision of the 
elbow-joint. The only two published cases, he re- 
mark.s, where it had been performed late in life, were 
first by Mr. Erich.sen, at the age of sixty-three, issue 
successful ; second by Mr. Beckerslette, of Liverpool, 
aged sixty-four, Avhen the patient died of exhaustion 
on the twenty-sixth day. 

Hesit.vtion in Curing Eczema. — Mr. Milton {Med. 
Press and Circular) for years has done his best, in 
every instance, to check the discharge of eczema as 
quickly as possible. During that period above 5.000 
cases have passed under his notice. He concludes that 
the fear of curing eczema, of however long standing it 
may be, and how^ever delicate the health of the patient, 
is not warranted by either proof or analogy ; that no 
known agent po-sesses the power of repelling eczema; 
that we can cure it only by means which improve the 
health at the same time; and that it is as justifiable to 
arrest its discharge as that of diarrhoea or cholera. All 
that has been said of eczema may be said of ulcer; 
there is no danger of healing it up, no bad symptoms 
ever aro.se from doing so. 

Alabama Insane Hospital, Tuscaloosa. — The elev- 
enth annual report of this institution, for 1871, exhibits 
the following: Oct. 1, 1870 — there were 222 patients 
under treatment. Since then, 139 have been admitted, 
making an aggregate of 361 under treatment during 
the twelve months ending Oct. 1, 1871. Of this num- 
ber 33 were discharged recovered, 9 improved, 5 un- 
changed, and 26 died. Remaining in hospital Oct. 1, 
1871, 288. 

Of the causes of death, marasmus carried off 8, epilep- 
sy 4, exhaustion 4, heart disease 3, and renal disease 2. 
Of those remaining 149 are men, and 139 are women — 
50 are colored. The building was built to accommodate 
just 250 patients. The cost per annum, of each patient, 
was $211.86. The average cost to the twenty -two 
prominent insane institutions of the United States, per 
capita, for the maintenance of the insane, is $272.48 



THE MEDICAL RECORD. 



43 



per annum. The treatment in this hospital was based 
upon the recognition of disordered mental manifesta- 
tions as consequent upon physical lesions, in accord- 
ance with tile advanced vicAVs in psychology. 

The resident ojicers are: P. Bryce, AI.D., siipt. and 
physician; John Little, AI.D., assistant physician. 

SuLPiiuu IX THE United States. — On the shores of 
the Mississippi, below New Orleans, two miles from 
the sea, in malving an artesian boring, a stratum of pure 
sulphur, 100 leet thick, was discovered at the depth of 
54;5 feet. — Xew Remedies — Trausl. from Zeitschrift des 
Oesterr. Apothek.- Vereins. 

Electrical Prize. — The prize of fifty thousand francs 
($10,000), ofTered by the Minister of Public Instruction 
in France, April 18, 1866, for five years, for the most 
useful application of the Voltaic Pile, was not granted 
to any candidate. The competition has been extended 
for another five years, terminating Nov. 29, 1876. 

The Actonian Prize. — The prize fund of two hun- 
dred guineas, offered by the Royal Institution for "The 
Theory of the Evolution of Living Things," will be 
awarded this year, as a single prize, or in sums of not 
less than one hundred guineas each. Competitors 
should send their essays to the Royal Institution before 
June 30, 1872. In December, 1872, the adjudication 
will be made. 

Medical Fees and Professorships, etc.. Abroad. — 
A doctor who is not celebrated costs four or five Eng- 
lish shillings in Paris, and a guinea in London. A 
professor at the College of France receives £300 ; at 
the Sarbonne, £480 ; or at the Paris School of Medi- 
cine, £400. A professor at Oxford has often from 
£1,000 to £3,00t>. The head-master at Eton has 
a salary of £6,680; of Harrow, £6,280; of Rugby, 
£2,960. 

Philadelphia Medical Times. — Dr. James Tyson, of 
Philadelphia, has retired from the position of assistant 
editor of this journal, in consequence of the demands 
made upon his time by professional engagements. 

The U. S. Army Medical Museum. — Fifteen hundred 
and sixteen new specimens were added to this Mu- 
seum during the year ending June 30, 1871. The total 
number is 15,018. During the year, 15,000 persons 
visited it. 

A Western Monthly Medical Journal Changes its 
Name. — The name of CinciJinaii Medical Hepertori/, 
with the opening of the year, has been changed to 
Cincinnati Medircd Keics. The editor is J. A. Thacker, 
M.D., assisted by the following associate editors: Drs. 
R. C. S. Reed, A. J. Miles, and D. D. Bramble. 

The Agency of the Mind in Etiology, Prophylaxis, 
AND Therapeutics. — Prof. Austin Fhnt, New York (Am. 
Pracdtioner)^ in a practical paper on this subject, re- 
marks : That the proper exercise of all the faculties of 
the mind, the sentiments as well as those belonging to 
the intellect, is the great requisite fur mental health, 
and consequently for happiness. 

Mental disorders not amounting to insanity, it seems 
to him, are not sufficiently considered by medical wri- 
ters, and their importance is apt to be underestimated 
b}^ practitioners of medicine. These disorders not in- 
frequently precede and lead to insanity ; and there are 
grounds for the belief that timely attention to the for- 
mer, on the part of the physician, would often prevent 
the latter. Those who give exclusive or special atten- 
tion to the treatment of cases of insanity, do not, as a 
rule, see patients until after they have become insane. 
The treatment of mental maladies, which precede and 



lead to insanity, must devolve upon the general prac- 
titionei-. 

In so far as bodily health and vigor afford protection 
against disease, the exercise of these sentiments is pro- 
phyhvciic. The state of the mind of a patient enters in 
many cases more or less largely into the prognosis. 
To develop and maintain this, hope and conlidence 
siiould enter, within proper limits, into the aims of the 
physician. In regard to the success in treating diseases 
and obtaining practice, the mental temperament of the 
practitioner has much to do in this matter. Some pliy- 
sicians are prone to look always on the dark ^ide of 
cases. Others are distinguished for always taking the 
most hopeful view of cases; they look ever on the 
bright side. The efiect is often more powerful than 
medication. There is an injudicious extreme in the 
latter direction, and between this extreme and the op- 
posite there is a golden mean ; but if there must be a 
deviation from this mean, it is desirable that it should 
incline to hopefulness rather than despondency. 

Aiken, South Carolina, as a Resort for Invalids. 
— This town is situated in the northwestern portion of 
the State, 120 miles from Charleston, and 17 miles from 
Augusta, Georgia. It is 600 feet above tide Avater at 
Charleston, and 400 feet above the Savannah river at 
Augusta. The South Carolina railroad passes through 
the centre of the town, making direct connection with 
the Charleston steamers from New York and other 
northern ports. The township contains 4 square miles, 
situated on a nearly level plateau. The streets are all 
150 feet wide, crossing each other at right angles. The 
building lots or squares contain 4 acres each, with one, 
two, or more houses. The streets are all well shaded 
with a great variety of the original forest trees ; such as 
oak (five or six varieties), pines, China, wild orange, 
mulberry, and black walnut. The soil is a white sand, 
with an under-lay of red clay. The sand varies in 
depth from 12 inches to as many or more feet. The 
wells and numerous springs furnish an abundant supply 
of pure, sweet, and limpid water. The welis vary from 
80 to 125 feet in depth. From the nature of the soil 
and the elevated location of the town, the climate is 
dry and moderately bracing in winter, rendering it a 
favorite place of resort for invalids from the North, 
especially those afflicted with pulmonary disease, from 
the slight cases of bronchitis to those of a more grave 
nature, and chronic affections of the nervous system. 
The climate in winter is delightful. Invalids can exer- 
cise in the open air from morning until evening without 
any unpleasant effect ; seldom needing an overcoat in 
the middle of the day. The dense pme woods, Avith 
their agreeable odor, furnish delightful drives and lides 
over the hard, level sand. This climate possesses more 
tonic properties than the milder but more debilitating 
climates of Florida or any of the West India islands. 
It is also entirely free from the moisture of those places 
situated near or surrounded by salt water. Those who 
visit Aiken as invalids are frequently injunjd by not 
taking timely advice, either of their physician at home 
or of some one resident in this place, as to exercise, 
diet, and general hygienic management while here. 
They come here for the benefit of the pure, fresh, and 
invigorating air; and are apt to think they cannot liave 
too much of it. Or else they may arrive when we are 
experiencing one of our cold, windy "spells of weather," 
and shut themselves in their rooms, stuff all the cracks 
with cotton, and with a rousing fire of Black Jack and 
light wood deceive themselves into the belief that they 
are doing the best they can to receive the full benefit 
of the climate ; or else heap curses and maledictions 
on the climate and those whose advice they followed in 



44 



THE MEDICAL RECORD. 



coming here. A little advice from an intelligent phy- 
sician, who imdor-itniula llic climate and it;' effects, 
woulil save all this; and in many ca«e.s the life of the 
patient would be prolonged if a permanent cure was 
not effected. 

The accommodations for inva'ids are for the most 
pari first-class. With the hotel, the Sanitarium, and 
private hoarding-houses, there arc aocommoJations for 
about 400. Most of the private boarding liouses are 
situated either in tlie centre of the town, or near 
enough to bo of easy nccoss. 

Prof Saml. Henry Dickson, M.D., of Jefferson Medi- 
cal College, Pliiladiliiliia, a former resident of Charles- 
ton, says: " I have long regarded the town of Aiken, 
or rather the country immediately surrounding it, as 
among the most agreeable arid healthy loc:ditie3 in our 
Atlantic States, so far as climate and topographical 
conditions are concerned. A sandy soil, and an at- 
mosphere fragrant witli tlie pleasant smell of the pines 
which form the prevailing growth for miles about, a 
genial, sunshiny sky, pure air, and limpid, sweet water 
constitute a sjt of circumstances highly favorable to 
the preservation of health to the sound, and its resto- 
ration to tlie invalid. The region is especially adapted 
as a winter and spring residence to those generally 
who suffer from affections of the respiratory organs 
from the most serious cases of consumption to the 
lighter but often tenacious attack of chronic catarrh 
and bronchitis. I have often been called on to give 
advice to pati?nts laboring under these maladies and 
chronic affections as well of the digestive organ, and 
have found them in a majority of instances to be 
benefited by a residence in and near Aiken, both in 
winter and summer. 

'• Dr. Percival. a resident of Aiken, presented to the 
American Medical Association, at its meeting at Wash- 
ington two years since, an account of this place of re- 
sort for Northern invalids which, however wrong it 
may seem, is really entirel}' truthful and without exag- 
geration." From an experience of one season at 
Aiken, I can bear witness to the truth of all this, 
although the last winter was one of unusual severity 
not only in Aiken but throughout the States, Florida 
not even excepted. This may and probably will not 
occur again in a number of years. Even last winter, 
the benefit received by those w-ho were advised to be 
prudent, more than overbalanced the evil to the oppo- 
site class. 

A great variety of vegetables are raised here in 
abundance, and can be procured fresh nearly the year 
through. The best of beef and mutton, from East 
Tennessee, can be procured, with but little trouble, at 
the markets in Augusta. Poultry and game are 
abundant. A great variety of fish can be had from 
Charleston and Augusta. Oranges from Florida. Ap- 
ples from the North and West. Canned fruits are as 
cheap as in New York, and can be had in every va- 
riety. The material for food is abundant. There is no 
necessity for any one to go hungry or contract dj'spep- 
sia if he only hits upon the right place to indulge his 
gastronomic propensities. 

" Fem.vle Pills" .\s Abortifaciexts. — The sum 
paid for these quack remedies in the United States is 
estimated by investigators at about one million of dol- 
lars. Dr. Ely Van De Warker, Syracuse, N. Y. {Jour. 
Gyncpcological Society) believes the crime of abortion is 
more common in Protes'ant countries than in Catholic. 
Among the Roman Catholics the indi.screet maiden re- 
ceives the crown of motherhood. She has been taught 
from childhood to bow before the reality of an unborn 
soul. To the Protestant woman of many sects such a 



reality cannot exist. The belief finds no place in her 
heart, that the embryo of coming manhood within 
her has roused pulses of love not unmarked in heaven. 

UiiinXhv Calcilus in CniNA. — According to J. G. 
Kerr, of Canton, (.'hina (iV. V. Med. Journal), stone in 
the bladder is confined almost entirely to the province 
of Canton; it is a remarkable fact that the disease is 
not known to exist only in tlie Southern portion of 
the Chinese Empire. Why the disen.se should be so 
common in the South of China, on latitude 2'.\Y, and 
entirely absent in the central or northern parts, is a 
curious question, not easy to be answered satisfactorily. 

The first operation for stone in the bladder pcrlbrmed 
in China was in 1844, by the Rev. P. Parker, M.D., the 
ibunder of the Medical Mi.ssionary Society, and now a 
resident of Washington, D.C. From that time ti; 
1853 about 37 cases were operated on by him. Since 
the year 18-")(J lithotomy has been performed 187 times, 
with 19 deaths; the cases of lithotrity for the same 
period amount to 30, with 3 deaths. The ordinary 
lateral operation with the s?alpel has been performed iu 
most of the lithotomy cases. Generally the incision 
was not extensive, and reliance was placed on dilatation. 
In one or two cases the median ojieration was resorted 
to. 

Sir Henry Thompson's lithotrltc, made by Wei^, was 
used in most of tlie lithotiity cases, and seemed to be 
as nearly perfect in its adaptations to the purpose re- 
quired as it is possible for any instrument to be. 

Thirty-seven of the lithotomy cases were operated 
on by Dr. F. Wong, a Chinese physician educated in 
Boston,'' Mass., and in Edinburgh. He is the only 
Chinese who has performed the operation. 

Maltine. — This substance, called diastase, first re- 
ported by Payen and Persoz in 1833, is recommended 
in dyspepsia, either with or without pepsine, by Prof. 
De Renzi. The subjoined formula is laid down in La 
Kuova Ligiiria Medicah : R. Maltine, centigr. xv. F. 
pil. No. 3. One pill before each meal. K. Maltine, 
centigr. v. to x.; Pepsine, centigr., c. to cl. F. doses No. 2. 

Stramonium ax Axtidote to Opium Poisoxing. — 
In two cases, Dr. D. B. Putnam, of Boston, Mass. {Boston 
Med. and Surrj. Journal), has used stramonium as an 
antidote to poisoning by opium, and from the prompt- 
ness and certainty of effect manifested in these cases, 
he would suggest to others a trial of its virtues in 
cases of this character. 

Medical Department of the Universitt of 
Vienna. — This institution was founded in 1787, by the 
Emperor J'rancis Joseph II. It is of brick, two and 
a half stories high, and covers an area of ten acres or 
more. The number of wards is 110, and they contain 
2,500 beds. There are 28 civil and 52 medical officers ; 
all of whom receive pay. About 20,000 patients are 
admitted annually, besides tliose in the lying-in wards. 
From eight to ten thousand children are born in the 
obstetrical wards during the year. Bilroth and Du- 
meicher are the surgeons, Braun and Spiit the obste- 
tricians and gynaecologists, and Hebra and Neumann 
hold the chairs of dermatology. Sigmund and Zeisel 
lecture on syphilis, Jiiger on the eye, and Rokitansky 
on |)atliological anatomy. Excellent as is the faculty 
and splendid the clinics, it is from the assistants that 
the most practical le?sons are obtained. They teach 
everything. Pro*'. Braun is about fifty years of age, 
has a pleasing face, and is thoroughly German in ap- 
pearance, lie delivers his lectures sitting; speaks 
very slowly and distinctly, but with little animation, 
offering in this respect a striking contrast to the fiery 



THE MEDICAL RECORD. 



45 



style of his nssistant, Rokitansky, Jr., wliobkls fiiir in 
his chosen field to rival the reputation of his illustrious 
sire. — Vienna Corresp. Am, Practitioner. 

Retention of a Wooden Pessary Skventekn 
Years. — Dr. J. J. Kenipe, of Milwaukee {NortluL-esteni 
Med. and Surg. Journ.), recently removed a ring-shaped 
pessary from a German woman, which was forcibly in- 
troduced, 17 years ago, by a physician in Germany for 
complete prolapsus uteri. The pessary, made of a wood 
similar to our hard maple, measured three and one- 
eighth inches in diameter, and the outer border was 
one-half inch in thickness. The instrument originally 
was covered with leather, which came away about 
eighteen months after introduction. 

The patient had sought to obtain partial relief from her 
suffering by repeated and long-continued traction upon 
the pessary, and in this way an urethro-vaginal fistula 
was originated— by pressure of the tissues between the 
arch of the pubes and the outer border of the ring. 

Bichloride of Methylene. — Samuel Theobald, M.D., 
of Baltimore, Md., London correspondent of the Bait. 
Med. Journ., writes that the advantages of bichloride of 
methylene as an anaesthetic, have been largely tested 
at Moorfields Hospital, London. No dangerous or un- 
pleasant symptoms caused by its administration have 
been noticed there. The advantages which it possesses 
over chloroform are, that it produces its effect much 
more rapidly, and is more evanescent in its action. 
These properties recommend it more especially for ope- 
rations of short duration. In its administi-ation, it 
should be diluted with a much smaller percentage of 
air than chloroform. To an adult from one or two 
drachms may be administered at once, and this will 
generally prove sufficient if the operation is of short 
duration. If desired, however, it may be repeated (four 
or five times), in drachm doses, as soon as its influence 
begins to pass off. 

The Sphygmograph. — This is the title of a beauti- 
fully printed monograph of thirty pages, published by 
Wm. Wood (fc Co., and written by Edgar Holden, 
M.D., of Newark, N. J., in which the subjoined instru- 
ments devised to carry on his observa'.ions are particu- 
larly referred to, viz. : the sphygmograph already 
described in the Medical Rkcord. an artificial heart 
and capillary apparatus made of rubber ; a large sphyg- 
mograph two feet in length, adapted to record its 
workings. 

The author announces that this essay, originally read 
before the Medical Society of New Jer.sey, is prepara- 
tory to a larger work on the practical value of the 
sphygmograph and the physiology of the circulation. 
The writer, after referring chiefly to tracings of the 
pulse in connection with cardiac pathology, says in 
closing: " With a new principle and a simpler and less 
costly instrument within reach, sphygmography will 
rise into a definite and useful science. Certain it is 
that by it, even now in its immaturity, we may detect 
deviations from perfect health not discernible by any 
other means, and consequently in at least one, and a 
growing interest in this country, namely, the estima- 
tion of possible longevity, it will be invaluable." 

The attention and perusal of all interested in the 
workings of the sphygmograph is called to this useful 
book, which presents, in a form convenient for reference, 
the results of his own experience. 

Transactions of the Medical Society of the State 
OF North Carolina. — This pamphlet, containing the 
minutes of the eighteenth annual meeting of this Soci- 
ety, held at Raleigh, N. C, May, 1871, also exhibits 
creditable papers by the following gentlemen : " Report 



of a case of Scleroderma atid two of Empyema," by 
Robert J. Hicks, M.D. ; "Operation for Traumatic 
Aneurism of the Superficial Palmar Arch," " Cranio- 
tomy and Operation for Vesico- vaginal Fistula," by E. 
Burke Haywood, M.D., Raleigh. Dr. R. L. Payne, of 
Lexington, gives an interesting address on "Some of 
the duties of the Avorthy i)hysician, and some of the 
obligations due the worthy physician by the commu- 
nity." The following officers were elected lor the en- 
suing year: Premlent, Di-. William G. Hill. Raleigh, 
N. C. ; Vice-Presidents, Drs. H. W. Faison, R. J. Hicks, 
(iid. H. Macon, and W. A. B. Norcum ; Treasurer, Dr. 
J. W. Jones, of Farborough ; Secretary, Dr. James 
McKee, of Raleigh. 

Artificial Milk. — Among the melancholy records 
of the siege of Paris may be counted those on the 
utilization of strange materials for food ; not the least in- 
teresting of these being the researches of M. Boillott, 
M. Dubrunfant, and M. Charles Fua on " Alimentary 
Fats." 

"Alimentary Fats" is a wide expression, including 
some rather unsavory hydrocarbons and very curious 
refuse materials. The main object of these iiivestiga- 
tions was to determine how such substances may be 
" usefully employed in alimentation," or, in plain, un- 
sophisticated English, how to make butter from candle 
ends, dirty drippings, colza oil, fish oils, the refuse of 
slaughter-houses, the restored greasa of the wool- 
dresser, etc. The general result has proved that the 
"frying process" is triumphant over its rivals; that by 
simply raising the temperature of the fat to 140° or 
150" centigrade, and in the mean time cautiously sprin- 
kling it with water, the cellular tissue, the volatile oils, 
the rancidity, offensive odors, and all other non-senti- 
mental impediments to "alimentation " are removable. 

This frying process has already effected something 
like a revolution in the industry of soap-boilers, some 
of whom have changed their trades to that of butter- 
fryers. 

M. Dubrunfant is not content with superseding the 
cow in the matter of butter, but has made similar at- 
temps upon milk. He contends that milk is simply an 
emulsion of neutral fatty matter in a slightly alkaline 
liquid, such as can be artifically imitated ; and that the 
process of churning consists in hastening the lactic fer- 
mentation, thereby acidifying the serum of the milk, 
and at the same time agglomerating the fatty matter 
which the acidity sets free from its emulsion. He fur- 
ther controverts the cellular theory by showing that 
fat-globules of milk do not display any double refrac- 
tion, as do all organized membranous tissues. 

Having thus examined the theoretical constitution 
of milk, he proceeds to the practical method of imitat- 
ing it, and gives the following directions: Add to half 
a litre of water forty or fifty grammes of saccharine 
material (cane sugar, glucose, or sugar of milk), 
twenty or thirty grammes of dry albumen (made from 
white of egg), and one or two grammes of sub-car- 
bonate of soda. These are to be agitated with fifty or 
sixty grammes of olive oil, or other comestible fatty 
matter, until they form an emulsion. This may be 
done with either warm or cold water, but the tempera- 
ture of 50° to 00° C. is recommended. Tlie result is a 
pasty liquid, which, hy further admixture with its own 
bulk of water, assumes the consistency and general ap- 
pearance of milk. 

Luxuriously- minded people, who prefer rich cream 
to ordinary milk, can obtain it by doubling the quantity 
of fatty matter, and substituting two or three grammes of 
gelatine for the dry albumen. The researches of Dumas 
and Fremy having reinstated gelatine among the nitre- 



46 



THE MEDICAL RECORD. 



genmis nlimentftry matoriala, M. Dubniiifniit profers it 
to albumon ; it is rlioai)or, more easily obtaiiicil, and 
tlio sliglit viscidity wliicli it (ifivis to tlie litjuid, materi- 
ally assists the formation and maintenanie oftlie emul- 
sion, liy sulislitulinp vegetable idbuinen for the white 
of cpg or pelatine the vegetarian may prepare for liim- 
BeU a milk that will satisfy his uttermost aspirations. — 
Nature. 

A New Qlautkrly lias made its appearance in Eng- 
land, called ' T/ir (rermnii Qiiarlerli/ Mdijazine: a Series 
of Popular Es.«ays on Science, History, and Art.'' The 
first number contains three papers : — " The Cranial 
AfTmiiics of ^[an and the Ajyo," by Rudolpli Virchow ; 
" Sight anil the Visual Organs,'' by A. von Graefo ; and 
" Tlie circulation of the Waters on the Surface of the 
Earth," by II. W. Dove. 

Conjoint Examinino Board. — It is stated that all 
of the English Universities have accepted tlie draft 
scheme as proposed by the College of Physicians and 
the College ot Surgeons, for a Conjoint Examination 
Board. Tliere appears to be every probability of its 
soon being put into effect. 

Loris KosscTii communicates to the Neue Freie 
Presse of Vienna the remarkable curative qualities pos- 
sessed by a grotto near Pistoies, in the Valley of Luc-» 
ques and Pisa, the virtues of which consist in radically 
curing the gout. 

The treatment is easily followed, and lasts from eight 
to fifteen days. 

The patient descends into the grotto, which is well 
lighted, covered with a bathing-gown. There he has 
only to sit and admire the stalactites, or converse with 
his friends. After ten minutes he sweats profusely, 
but not disagreeably. 

After an hour he is taken out. wrapped in a flannel 
covering, and after reposing a little, subjected to a cold 
shower-bath. 

The curative principle of the grotto is, however, an 
enigma. 

In the warmest parts of the grotto the air does not 
show more than thirty-two to thirty-four degrees (cen- 
tigrades), and is less oppressive than the air outside; 
the water is still colder, but it is heated by the air, the 
chemical composition of which resembles that of atmos- 
pheric air ; the only difference being a slight addition 
of azote. 

Ko.-suth attributes the remarkable qualities of the 
grotto to electro-magnetic agents. 

The subterraneous grotto in question was discovered 
some years ago by a number of quarrymen engaged in 
excavating stone. 

An E.xtremely Curious Pathological Fact, in the 
highest degree interesting to the scientific world, was 
signalled this week in Paris. 

On the 6lh of February M. Roux, sluice-keeper at 
the station on the Seine, opposite the mint, withdrew 
from the river the evidently lifeless form of a woman 
who had thrown herself in two hours previously, but 
who in spite of the most active measures, could not be 
discovered sooner. 

The body laid upon the quai was cold and rigid, the 
face livid, the pulse of the poor woman had ceased to 
beat, and so sure were the bystanders she was dead 
that not the slightest effort was made to restore her to 
consciousness. On the arrival of the ))olice commissary 
Dr. JuRien thought he still perceived some feeble in- 
dications of life in the apparently inanimate body. 

On minute examination he found that, notwithstand- 
ing her long submersion beneath the Seine, the 
functions of life had not completely ceased. 



Dr. Jullieii in turn tried fumigations, friction.'', and 
the breathing of air into her lungs. The beatiiij^ of the 
heart, feeble and uncertain at first, gradually became 
stronger and more regular, until she finally became 
conscious, and could with safety be transported to the 
nearest hospital. 

In falling into the Seine .she had been seized with 
a syncope, which during the two hours of her immer.sion 
in the river had completely suspended the functions of 
life. Her name is Jeanne Duboi.s, and adilre.ss, 52 Rue 
de Seine. 

Monsieur Tei.lier ha.s di'^covered a new method of 
preserving meat for an indefinite period of time, by 
submitting it to the action of melhylic ether. 

When once it is proven that meat thus treated, pos- 
sessing intact its qualities of freshnes.s, may be trans- 
ported to Europe at little cost, in a frozen state, from 
Australia, South America, and the west and south of 
United States, the welfare of the mas.se3 in overstocked 
Europe will be greatly advanced ; with the boundless 
resources of the New World at their disposal on easy 
terms, a new era will be opened to the working 
classes. 

Swallowing a Fork. — An individual in Florence 
named Hegisto Cipriano, while imitating the tricks of 
Japane.se jugglers, was seized with a fit of coughing, 
and had the misfortune to swallow the metal fork with 
which he was experimenting. 

Conveyed to the hospital, the most experienced 
physicians there endeavored by every possible means 
to extract the fork from tlie stomach, but without suc- 
cess. 

As he is able to eat and drink with the greatest 
freedom-, and enjoys general good health, the medical 
men attending him are in hopes that the fork will be 
gradually digested, and that ti)e result of the accident 
will not be fatal. 

Home for Incurables, West Farms, X. Y. — The 
Fifth Annual Report of this Institution gives the fol- 
lowing exhibit: — Whole number of patients under the 
care of C. F. Rodenstein, M.D., the attending physician. 
during the year ending June 1st, 1871, 57; number in 
house at last report, 35 ; admitted during the year, 22 ; 
died, 9 ; removed, 5 ; now under treatment, 43. Clas- 
sification of diseases. — Hemiplegia, 13 cases ; debility, 
6 ; dementia, 4 ; epilep.sy, 5 ; progressive locomotor 
ataxy, 3 ; phthisis pulmonalis, 4 ; paraplegia, 2 ; rheu- 
matic gout, 4 ; and softening of the brain, 2. The 
remaining 12 cases represent as many different diseases. 
The annual meeting of the Society was held at Asso- 
ciation Hall, New York City, June 12, 1871, and 
appropriate addresses were made bv Chancellor Crosbv, 
Rev. Noah H. Schenck, D.D., Rev. S. H. Tyng, Jr., 
and Hon. Erastus Brooks. Contributions are sohcited, 
which may be sent to J. D. Vermilye, Treasurer, Mer- 
chants' National Bank, 42 Wall street, N. Y, City. 

The Photometer. — A newly-invented photometer 
proves that light penetrates 100 fathoms below the 
.surface of the sea — 70 fathoms more than hitherto sup- 
posed. 

A Centenarian. — The most remarkable centenarian 
alive is probably Thomas Fitzgerald, of Rhinebeck, 
N. Y.. who is one hundred and eight years old. He 
lives with one son, while his wife, one hundred years 
old, lives with another at Rondout and keeps house for 
him. Mr. Fitzgerald u.ses tobacco, but has always 
been strictly temperate. He is very deaf, but his eye- 
sight is good, and he can thread a needle at arm's length. 
He strops his razor, shaves himself, dresses and 



THE MEDICAL RECORD. 



47 



undresses, nnd Avithin the year hns chopped and put 
up six cords of wood. His occnpation has been that of 
a fisherman and laborer. He is a native of Irehind, 
and was thirty-four years of age at the time of the 
Irish rebellion in 1798. 

Berardius Aruxxii. — A unique specimen of the 
rare animal, lierardius Arunxii, of Dnverney, 30 feet in 
length, has been recently given to the Hunterian 
Museum, by Mr. Erasn.us Wilson. Only four of these 
creatures have been discovered, all on the coasts of 
New Zealand. 

De.vtii from Hypodermic Injection of Morphia. — 
Dr. Stanton, of New Brighton ,Pa., relative of the late 
Secretary Stanton, and Auditor-G-eneral of the State 
of Pennsylvania, lately died from the effects of an 
hvpodermic injection of morphi;), administered by him- 
self to produce sleep, in tlie inner part of the arm near 
its junction with the shoulder. The dose was about 
one grain. Death occurred six hours after its admin- 
istration. In the opinion of those physicians Avho 
witnessed the death scene, his death was caused by 
the unusually prompt and complete absorption of the 
morphia, prostrating a system already struggling with 
cadaveric poisoning. 

Scarlet Fever in Great Britain. — During the last 
sixteen years the losses i'rom scarlet fever in Great 
Britain were not less than 100,000 lives. 

Chloride of Sodium. — In the year 1871 nine million 
bushels of common salt Avere manufactured in the 
neighborhood of Syracuse, New York. 

Analysis of Milk. — Dr. P. Schweitzer, of the School 
of Mines in Columbia College, New York (Journ. A])- 
2ilied Chemistry), in his examination of the milk fur- 
nished to the inhabitants of this city, reports that in no 
samples were any injurious ingredients found, tiieonly 
adulteration being water. 

The specific gravity of pure milk adopted by the 
English is 1.029; it should contain from 12i to 13 per 
cent, solid constituents, the rest being water. The 
solid portions are made up of 

Ordinary Milk. Condensed Milk. 

Ash 0.70 2.60 

Butter 3.80 13.12 

Casein 4.10 14.44 

Sugar 4.20 16.30 

12.80 46.46 

New York State Lunatic Asylum, Utica. — In a 
voluminous paper on "Materialism in its Relations to 
the Causes, Conditions, and Treatment of Insanity," 
read before the Association of Superintendents of Insane 
Asylums, at Toronto, by II. B. Wilbur, M.D., Sup't of 
the New York Asylum for Idiots (Journ. of Psyc/wlo- 
f/ical Medicine), the statistics of the Utica Asylum for 
27 years ending Nov. 30, 1869, are cited to show that 
the percentage of recoveries, during the later years, has 
not been an increasing one. He would not be under- 
stood as presenting them to prove that they are less 
favorable than in the case of other institutions during 
the same period, but as showing that the modern 
system of treatment, based upon the exclusively " physi- 
cal basis" theory of insanity, is no more successful 
than in former times, though it must be conceded that 
the resources in the way of remedial agencies have 
been greatly enlarged. 

The partial statistics of three Massachusetts institu- 
tions, he believes, indicate that the medical treatment, 



when pushed, is no more successful than when less 
vigorous medication is employed. 

According to this author, in the last six years, the 
average annual cost of medicines, for each patient, 
at the Utica Asylum, has been $7.94. In the six years 
of Dr. Brigham's administration, Avhen the moral treat- 
ment was made very prominent, he states that the 
average annual cost of medicine and medical supplies 
for each patient was $1.15. 

The Man with the Iron Jaw. — Mons. D'Atalie, or, a.s 
he is commonly known, " The Man with the Iron Jaw," 
was presented recently at the surgical clinic of Pro- 
fessor Mears, in the Penn. College of Dental Surgery, 
for an examination of his maxillary apparatus. From 
early life he has been engaged in a gymnasium. His 
first efibrt to raise weights, grasped by his teeth, was 
made tiiree years ago, when he made an attempt to lift 
a heavy table. This effort was successful, and now he 
is able to raise seven hundred pounds. His maxillary 
apparatus does not present any extraordinary develop- 
ment; on the contrary, there seems to be an absence of 
any very full development of the various parts which 
enter into its formation. 

Mons. D'Atalie holds heavy weights by placing the 
part seized between both the anterior and postei-ior 
teeth, so as to employ all the elevators of the jaw. His 
power does not reside alone in the muscles of the jaw 
— those of the neck and body play an equally im- 
portant part in all of his feats of strength. — Denial 
Times. 

Proceedings of the State Medical Association of 
Arkansas. — The second annual session of this Society 
was held at Little Rock, Arkansas, November 5th and 
6th, 1871. The annual address was delivered by the 
President, Dr. P. 0. Hooper. Interesting communica- 
tions were read by Drs. R. G. Jennings, W. H. Haw- 
kins, E. R. Du Val, and Geo. W. Lawrence. Nine local 
medical societies, representing fifty members, compose 
the parent society. The following officers were elected 
for 1872: President, J. M. Holcombe, of Pine Blufi"; 
Vice-Presidents, Drs. O. A. Hobson, J. F. Davies, and 
W. "W. Bailey ; Recording Secretaries, Drs. E. V, Deuell 
and Ed. Cross, of Little Rock ; Correspondimj Secretary^ 
Dr. Claiborne Watkins, of Little Rock; Treasurer, Dr. 
J. B. Bond, of Little Rock. 

Chinese Surgery. — John G. Kerr, M.D., Chief-Sur- 
geon of the Canton (China) Hospital {Cin. Lancet and 
Observer), writes that the department of surgery in this 
empire can scarcely be said to exist, beyond the appli- 
cation of caustics and plasters to tumors and ulcers, and 
of poultices to broken bones. They are entirely help- 
less. There is no native doctor in all China who can 
give aid in any case of accident or disease which re- 
quires manual or instrumental interference. The ines- 
timable benefits of operative surgery in all its branches 
are unknown to them, except so far as they have been 
derived from a few foreign physicians and the pupils 
instructed by them. They are entirely without surgi- 
cal instruments, and all the apparatus which modern in- 
genuity has applied to the relief of injuries, deformities, 
and disease. In the instruction of students there, by 
foreign medical men, there is a want of suitable text- 
books in the Chinese language. A beginning was made 
in this department some years ago by Dr. Hobson, of 
the London Missionary Society, who published the out- 
lines of several branches of medicine in four volumes. 
He inquires : Are there not many of those who are 
aspiring to the honors of the medical profession, who 
will be ambitious thus to benefit so large a portion of 
the human family ? 



4B 



THE MEDICAL RECORD. 



The Drco Trade or Chicago and thk Fiiik.— Of 
the 100 r.'tftilers of driips in Chicago, upwanls of (ifiy, 
or more than cne-thiid of the whole niinibor, lost their 
all ill tlie wide-spread desolation. The sinn-total did 
not fall <-iiort oC JJIUO.OUO. before llic fiie, the gross 
sales of the icadinjr wliolesalc diugf:ists amounted to 
$'),(iOO,OOt) annually. Of the six wholesale druppists 
wlio were entirely burned out, five have re--umcd busi- 
ness and are transacting business with their usual de- 
spatch. 

A Vkuv Old Man.— Harvey Thncker, who died 
recently in California, was one hundred and twenty- 
eight years old at the (iate of death. He was tlic son- 
in-law" of the famous Daniel Boone, the first settler in 
Kentucky. 

A Gift to the Kentucky Puhlic Librarv. — Dr. 
Christopher Graham, one of the oldest and most es- 
teemed citizens of Kentucky, lias presented to the 
public library of that State his collection of minerals, 
fossils, and geological specimens, valued at $30,000, the 
work of fifty years. 

TiiK Laugest Consulting Practice in the Would. — 
Dr. Gull, of Guy's Hospital, London, is said to have the 
largest consulting practice of any phy.^ician in the world 
—worth not less than £25,000 a year ($ll>5,000j. 

LoNGEViTV OF FARMERS. — According to Dr. Nathan 
Allen, of Mass., in his registration report of dcatlus in 
that State for thirty years, tlie cultivators of the earth 
stand as a class at the head, reaching, on an average, 
the age of nearly G5 years. 

Value of Salt. — In Africa the liigh-caste children 
suck rock-salt as if it were suga", aUhougli the poorer 
classes of natives cannot indulge their palates. Hence 
the expression in vogue amongst them, " He eats salt 
with his victuals," signifying that the person alluded to 
is an opulent man. In those countries where mineral 
salt is not procurable, and where tlie inhabitants are 
far removed from the sea, a kind of saline powder is 
prepared from certain vegetable products to serve in its 
stead. Indeed, so highly is salt valued in some places, 
that from its very scarcity it is employed as asubstitute 
for money.— Food Journal. 

Nationalities Relieved in Chicago, III. — "We learn 
from the First Special Report of the Chicago Relief and 
Aid Society, that the sufferers by the fire were of all 
nationalities; and of 18,478 families who needed suc- 
cor, 1,985 only were of native birth. The number of 
Irish families' was 5,512; German, 7,280; Scandina- 
vian, 2,104; English, 599; Scotch, 195; French, 185; 
Italian, 112; Bohemian, 208; African, 241; Canadian, 
94 ; Polish, 90. Ten other nationalities were represent- 
ed. Up to Nov. 30, 1871, only one death occurred 
among a population of 5,000 in barracks. 

The Treasurer, Geo. M. Pullman, reports the receipt of 
$2,485,884.55 up to November 18th, inclusive — of which 
$493,4G0.3G had been judiciously distributed, leaving a 
balance in sixteen different banks of $1,190,424.19, 
drawing five per cent, interest. The officers of this 
Society, incorporated February IG, 1857, are men of 
high standing, and are entitledto the confidence of the 
cora-nunity. Since this Report was written avc learn 
that the aaiount received up to January Gth, was $3- 
335,700. The balance on February 3d was $1,314,G29. 

The Roosevelt Hospital, New York. — The Trustees 
of this new Institution have published the learned ad- 
dress by Thomas E. Vermilye, D.D., LL.D., made at 
its opening, Nov. 2, 1871 — with opening address by 



Edward Delafield, M.I)., the President. Interesting sta- 
tistics are given, in which he mentions that physicians 
and surgeons were first established in Infirmaries in 
1437. The Knights of St. John opened a lio.spital for 
sick pilgrims at Jerusalem in 1048, and were styled 
Kniglits Hospitallers. There were hospitals for the 
sick at Constantinople in the eleventh century. They 
sprang then from the bosom of Christianity. 

Death of Dr. Bulklev. — Resolved, That in the 
death of Dr. Henry D. Bnlkley, the Medical Board of 
the Nursery and Child's Hospital have to deplore the 
loss of one of the earliest officers of the institution — 
a member of its consulting staff since its organization. 

Resolved, That the clo.se of his long life of usefiil- 
ness is covered with honor, and that his memory will 
be cherished by his former colleagues in this Board, in 
common with all who were associated with him, know- 
ing the inestimable worth of his private life, and the 
eminent skill and spotless integrity of his professional 
career. 

Resolved, That a copy of these resolutions be sent 
to the family of the deceased, to whom we tender our 
warmest sympathy, and that they be published in the 
medical journals of this city. 

T. M. Markoe, M.D., > ^ _ ... 
T T TT ^r V^ r Committee. 

J. J. Hull, M.D., ( 

S.MALL-i'OX. — The cases of small-pox in this city 
average the same — from seventy-five to eighty weekly. 
In Philadelphia the number is somewhat decreased, as 
is also the case in Boston and Chicago. The large 
towns throughout the State are beginning to develop 
the disease. Especially is this the case along the lines 
of our railroads. 

Academy of Medicine of Paris. — On account of 
the deaths of Drs. Poiseville, Fabret, Dan3'an, Leblanc, 
and Blache, five vacancies exist in the various sections 
of the Paris Academy of Medicine. 

Professor Huxley. — This distinguished savant will 
absent himself from England for the next two or three 
months — his health having given way. He will reside 
during this time in Egypt. 

King's College, London. — Dr. Priestley, of this Lon- 
don medical college, has resigned the professorship of 
obstetric medicine and physician for diseases of 
women. He has lectured on widwifery for the last 
fifteen years in this institution. 

Deaths of London Practitioners. — Robert Wade, 
F.R.C.S., who has left important papers and works on 
stricture of the urethra, recently was seized with a fit 
of paralysis, and died .shortly afterwards. 

Dr. J. Charles Hunter, L.R.C.P., formerly an in- 
spector of vaccinators to the National Vaccine Institu- 
tion, died December 19, 1871, act. 72. 

Rush ^Medical College, Chicago. — At the twenty- 
ninth annual commencement of this college — held 
January 17, 1872 — there were seventy-seven graduates. 

A New Monthly Medical Journal, called L' Union 
MidicaJe du Canada, has made its appearance in Mon- 
treal, edited by J. P. Rottot, M.D., with A. Dagenais, 
M.D., and L. J. P. Desrosiers, M.D., as assistants, and 
contains about fifty pages of the matter usually found 
in journals of that size; the principal article in the 
first number being devoted to a discussion of " The 
New Medical Bill," and of the question of " Medical 
Reform." 



THE MEDICAL RECORD. 



49 



©rigtital Communications. 

TWO CASES, ILLUSTRATING THE PRO- 
DUCTION OF VOWEL AND CONSONANT 
SOUNDS. 

By Pkof. E. M. MOORE, M.D., 

ROCHESTER, N. Y. 

The function of voice has always been a theme of inter- 
est to a wider circle of men than pliysicians. The most 
profound students of language, those who push their 
inquiries into the phonetic forms of the dim past, seek- 
ing to unravel the net of histor}"- in the twilight of the 
race, are perhaps more interested than any other class, 
except the ]iure physiologist. The students of San- 
skrit have brought forward elaborate and excellent 
treatises upon phonation, written more than three 
thousand years ago, pushing the inquiry as far and as 
accurately as mere observation could go. Since the 
discovery of the lar3'ngoscope tlie whole subject has 
undergone and is now undergoing a complete revision 
by the practice of auto-laryngoscopy, and we shall 
undoubtedly have the whole topic vastly advanced. 
Indeed it may be so far as to enable us successfully to 
initiate an inquiry into an anatomical explanation of 
certain phonetic laws which some profound German 
scholars have propounded, and also lead to the discov- 
ery of others. Tliese men look to the physiologists, in 
hopes that a law of anatomical and physiological rela- 
tion to sounds may be discovered, upon whii.'h to rest a 
solid foundation for the expansion of ethnology and 
L'omparative philology. 

The unanimity of opinion among physiologists, who 
have given their attention to the function of the larynx 
in the production of the voice, has led me to note two 
cases of striking interest, and so conclusive in their 
character that I think they will be regarded as an off- 
set to the experiments and observations that have 
heretofore been made, and upon Avhich opinion has 
rested. They have the merit of substituting fact for 
inference, and, indeed, fact bearing the potency of an 
experimentum crucis. In order, however, to the full 
understanding of the question, I will take Carpenter as 
the authority for the standard opinions, and recite his 
view on the subject at the point I propos3 to eluci- 
date. 

The doctrine of the reed-sound in the production of 
the larjmgeal voice, it seems to me, is firmly settled 
and universally admitted; the proof resting not only 
upon the form of the organ, but on the production of 
sound from the artificial larynx. Here at the vocal 
chords, the body of sound known as the sonant voice, 
in contradistinction to the whisper, is undoubtedly 
made. But the especial point to which this paper is 
directed is not this, but to the correction of opinion 
with reference to the production of vowel-sounds. 
These are asseverated to result from the passage of air 
along the mouth, and to be the effect of its modifica- 
tion, including, of course, the pharynx and nose as fac- 
tors. In proof of this I quote Carpenter. 

"The vowel-sounds are continuous tones modified 
by the form of the aperture through which they pass 
out; while in sounding consonants the breath suffers a 
more or less complete interruption in its passage 
through parts anterior to the larynx. Hence the really 
simple vowel-sounds are capable of prolongation during 
any time that breath can sustain them. This is not 
the case, however, with the real diphthongal sounds (of 
which it will presently appear that the English i is one). 



whilst it is true of some consonants. It seems to have 
been forgotten by many who have written on this sub- 
ject, that the laryngeal voice is not essential to the 
formation of either vowels or consonants; for all may 
be sounded in a whisper. It is evident, therefore, that 
the larynx is not primarily concerned in their produc- 
tion, and this has been fully established." 

Again he says: "That the vowel-sounds are pro- 
duced by simple modifications in the form of the exter- 
nal passages is easily proved, both by observation and 
imitative experiment. When the mouth is opened 
wide, the tongue depressed, and the velum palati elevat- 
ed, so as to give the freest pO:sible exit to the voice, the 
vowel a in its broadest form (ah) is sounded. On the 
other hand, if the oral aperture be contracted, the 
tongue being still depressed, the sound oo, the continen- 
tal M, is produced. If attention be paid to the state of 
the buccal cavity during the pronunciation of the dif- 
ferent vowel-sounds, it will be found to undergo a great 
variety of modifications, arising from varieties of posi- 
tion of the tongue, the cheeks, the lips, and the velum 
palati. The position of the tongue is, indeed, one of 
the primary conditions of the variation of the sounds, 
for it may be easily ascertained that, by peculiar inflec- 
tions of this organ, a great diversity of vowel-sounds 
may be produced ; the other parts remaining the same. 
Still there is a certain position of all the parts which 
is most favorable to the formation of each of these 
sounds; but this could not be expressed without a 
lengthened description. The following table, slightly 
altered from that of Kempelen, expresses the relative 
dimensions of the buccal cavity and of the oral orifice^ 
for some of the principal of these — the number 5 ex- 
pressing the largest size, and the others in like propor- 
tion : — 

Size of 
Yuwel sounds. Oral opening. Buccal cavity. 

a as in ah 5 5 

a " name 4 2 

e " theme 3 1 

" cold 2 4 

00 " cool 1 5 

" These are the sounds of the five vowels, a, e, i, o, ?/, 
in most continental languages ; and it cannot but be 
admitted that the arrangement is a much more natural 
one than that of our own vowel-series." Having 
made this quotation, I proceed at once to give the first 
case, bearing directly on this point : — 

Edward Larkin, tet. 50, born in Ireland, April 14, 
1871, attempted suicide with a razor. A cut was made 
immediately above the thj'roid cartilage, extending an 
inch each side of the median line horizontally, and 
shaving off the epiglottis at its base. The muscles be- 
low and above, by their tonic power, soon made an 
oval opening, two inches by | of an inch. Swallow- 
ing became impossible. On the fourth day he was 
brought to St. Mary's Hospital, having taken no food. 
No attempt was made to bring the edges together, trust- 
ing to the granulating process. A tube, introduced 
through the opening into the oesophagus, conveyed 
food to the stomach. This process was continued for 
about five weeks, when swallowing became possible, 
although the opening, which had become nearly circu- 
lar, was about half an inch in diameter. At the present 
time (June 10, 1871) he swallows solid food, but part of 
the liquid food will run out of tlie opening. At any 
time he was able to talk by bending his head forward 
and temporarily closing the opening. When the head 
was thrown back, he immediately lost this power. 

The experiment of enunciation of the alphabetical 
sounds, with the head thrown back, was made with the 
vowels first. The four sounds of a as in all^ arm, age, 



50 



THE MEDECAL RECORD. 



at, were at once disi inctly rendered. F, next attempted, 
alwnys resulted in n as in uije. (This, I tliink, must be 
jmt to the ni'counl of tlio llibeniian larynx.) 

y is a (liphthong, and was ck-arly reniltTod. 

O, botii long and sliort, was well brought out as in 
note and not. The short u as in cut, and represented 
by nearly all the other vowels, was also well pronounced. 

}' as /. 

The diphthongs were more difficult, and some could 
not be uttered ; 01/ as in onr was pretty well pronounced ; 
00, a pure vowel, was uniformly rendered as o in note. 

Oi, as in noise, could scarcely bo distinguished. 

The alphabet, taken in order, resulted in the enun- 
ciation of the vowel element. Thus our letter Ji was 
pronounced a, as also C and A There was absolutely 
no consonant uttered. The breathing, which is repre- 
sented by the letter //, was perfectly rendered. It was 
clear and smooth, and when joined to a vowel was 
spoken loudly and clearly. Thus, J/a and other sounds 
of(f, III and IIo, tilso Jin short, -wove i)ronounced with 
ease. A' and O' arc considered guttural aspirates. Any 
attempt to produce them resulted in the pure aspirate. 

These experiments were repeated on two difierent 
occasions, a few days apart, and with the same results. 
But on the second trial it was suggested that some air 
might pass into the mouth, and a curtain of buckskin 
was iitted to the upper part of the aperture, thus cut- 
ting off all the air that might reach the mouth. The 
result was the same. 

As regards the finish of the tones called vowels, 
there was clearly a defect. This might be due to the 
thickening of the mucous membrane, incident to the in- 
flammation in its immediate neighborhood — a good and 
quite sufficient cause. Or it might be explained by 
the absence of the modification by the mouth, tongue, 
and other parts, which have been supposed to create 
the sounds, but which, as is here shown, can only polisii 
and comj)lete what has been begun. But a little prac- 
tice will enable one to hold the parts above the larynx 
perfectly quiet, and still produce the vowel-sound. 
This case is so pathognomonic, if I can apply such a term, 
that it must reverse and settle opinion upon the seat of 
certain vowe'-30unds. 

The number of sounds that Larkin was able to enun- 
ciate is limited ; but I will now cite another case that, 
from its peculiar character, supplements the one just 
detailed, and by its results confirms the belief that 
Larkin's ability to enunciate as described would exist 
in all others, tims placing the seat of such vocalization 
as normal in all. 

During the year 1856 I Avas called into Orleans Co. 
to see Edward Matthews, wlio was suflfering from ur- 
gent dyspnoea. I arrived at his house in the night, and 
at once opened the crico-thyroid space. The relief was 
sufficient, and I did not see him again for a long time. 
Two years after, as I am informed, a piece of bone was 
removed from the opening, which had been kept free 
by a tube. This seemed to be lodged in the larynx 
somewhere, but the statement is too indelmite to be 
thoroughly understood. Nevertheless, there was a 
great abatement of unpleasant symptoms from soreness 
and dy,«pnoca. But slowly and gradually the glottis 
became closed, and for more than ten years a cicatrix 
has cut off the air from the trachea into the mouth, the 
closure being at the base of the larynx and absolute, 
not the least air passing through. Mr. Matthews, who 
is now forty-four years of age, is a man of intelligence, 
and has made great and constant efforts to enunciate 
clearly, and has improved much of latter years. Of 
course, every sound is a whisper, and also short, for the 
air ii driven by the buccinators and the muscles of the 
tongue and the supply of air is small. From this man 



we would expect to hear the consonnnis, if ho could 
speak at all, and this is essentially true. 

II and L he cannot jironounce, as they rc(iuirc a con- 
tinuous tone, and are interested in a quiescent state of 
tiie buccinators, wliich arc the chief means of forcing 
the air out. JJut even these sounds can be faintly 
traced in combination with others, in the con.vtruction 
of a word. Tlie pure breathing represented liy the let- 
ler II cannot be made at all, or in any combination. 
The single vowel-sounds of a, as in arm, uf, all, and aye, 
cannot be rendered at all. A blowing sound was the 
result of the effort, and when the finger was placed 
over the aperture in the trachea there was nb.solute 
silence. The cerebral command was obviou.sIy to the 
larynx. O was also silent, or resulting in 00, as in ooze. 
/, as in isle, was also silent when the aperture was 
closed, or a mere blowing sound if opened. 7i clearly 
enunciated, and this vowel is made in the front part of 
the mouth, by throwing the tip of the tonpue against 
the lower incisors and curling it upwards. While fixed, 
the continuous tone -f results. 

The nameless vowel represented by u as in nut, e as 
in err, i as in sir, and as in honor, sometimes styled 
the nnvocal, could not be uttered except in connection 
with consonants. 
Short o as in not, 
" e " net, 
" i " nit, 
could be rendered in conjunction with consonants, but, 
with the exception of short e, could not be rendered 
individually. The diphthongs were much more success- 
fully pronounced than by Larkin. 

Thus the soft u as in fjratitnde is a diphthong com- 
posed of e w (00) and was rendered beautifully. 

Oo'is really a very pure vowel, perhaps the most of 
any, if we except e, but it is not so placed in our cata- 
logues, and I can hardly understand why, unless it 
happens to be represented by a double character. This 
is made at the lips exclusively, as in ooze, and was ren- 
dered with great perfection. 

Oi as in noise, and ou as in our, both failed. 
As might be expected, the consonants are generally 
pronounced, most of them individually, but some only 
in connection with voweL^. 

B, C, D, F, G, K, P, T, X, Z, and V, pronounced as 
words and pure. But H not all. L and R very faint, 
when combined with e long. 
M and N in connection with vowels only. 
The consonants, P and T, made in the front part of 
the mouth, were more easily managed than the others. 
Accordingly the vowels within his capacity were sure 
to be brought out best between them. Thus: — 

Pet 1 Pretty well. 

Pit " " 

Pot " " 

Put " " 

Peet Admirably. 

Pout Not at nil". 

Pent Beautifully. . 

Pat as Put or Pot. 

Pate, not at all, or as Peet. 

Th, as in Thing and With Well. 

Ch, as in Church, and Sh, as in Shall. . .Well. 

Nt, as in Se7it Well. 

The conclusions that I arrive at from these two 
striking cases are these : — 

1st. That the larynx is not only the generator of 
voice (so called), but the actual seat of vocalization for 
the vowels a, in all its forms, i long, long, and the 
pure aspirate. Also the short vowels, which are also 
explosive, as i in sit, in not, and nameless one or 
unvocal. 



THE MEDICAL RECORD. 



51 



2el. That these sounds receive a finisli in the pha- 
rynx, nose, and mouth ; with the exception of tlie pure 
breathing and the short vowels. 

3d. The consonants are all made above the larynx. 

4th. The vowel e long is made purely in the front 
part of the mouth, also the vowel oo and the diphthong 
e«, which is composed of these two elements. 

5th. The short vowels (e in met) (i in sit) (u in nut) 
(o in not) can be made in the front part of the mouth. 

6th. The unvocal can probably be made in several 
places from the larynx to the front of the mouth. 

These propositions are nearly all mere statements of 
facts, but some are inferences. 

The observations on Edward Larkin were made in 
the presence of my colleagues Drs. Casey and Carroll 
of Sr. Mary's Hospital, and also of Prof Lattimore of 
the Rochester University. They were repeated on 
two occasions, a few days apart, but became afier a 
short time impossible from closure. 

Those on Mr. Matthews have been repeated on three 
occasion?, within the last three months: on cne in the 
presence of my colleagues in the Buffalo Medical Col- 
lege and several physicians and students of medicine, 
and on another, in the presence of Prof Mixer of the 
Rochester University, and Prof Palmer of the Normal 
School at Brockport — two gentlemen whose inteivst in 
the case arose from the fact that they were the teachers 
of languages in their respective institutions. Doubtful 
sounds have been carefully excluded, and I feel sure 
that no observations have been retained which are not 
clear and decided beyond cavil. 

CASES OF CEREBRO-SPINAL MENIN- 
GITIS. 
By JOHN DWYER, M.D., 

RESIDENT SCnGEON NEW YORK STATE EMIGRANTS' HOSPITAL, WARD'S 
ISLAND, N. Y. 

The following notes of six cases, typical of thirty cases 
of cerebro-spinal meningitis, treated in the Emigrants' 
Hospital during the years 1870 and 1871, may be of 
interest in connection with an inquiry made at a late 
meeting of the County Medical Society, "Whether any 
member had at present a case of cerebro-spinal menin- 
gitis under observation ? " 

Case 1. — Mary McG., aged IG, previously a strong 
healthy girl, living in a private residence on the Island, 
was rather suddenly attacked on 9th February, 1871, 
with a chill and headache which increased during the 
night; first saw her at 11 a.m. on the 10th, and found 
her shivering, complaining of acute pain in right frontal 
region, also in the lumbar region ; she was vomiting 
freely a yellowish-white matter. At 6 p.m. she was 
visibly worse, although vomiting had ceased and a solu- 
tion of quinine was retained in her stomach ; complained 
of intense pain in forehead and occiput, neck arched 
backwards, surface and extremities cold. She was 
screaming out for relief, had a wild look in the 
eyes, and she rolled restlessly about the bed, striking 
her head against the pillow. She was partly delirious. 
At 8 P.M. tiie right pupil was insensible to Hght, right 
foot and hand slightly convulsed. She suddenly began 
to sink, and died comatose a little after midnight, about 
thirty six hours from the attack. No post-mortem could 
be obtained. 

Case 2. — Peter Samelsen, aged 32, engaged in out- 
door work, suddenly attacked on 13th February, four 
days after case No. 1, with chills, prostration, and in- 
tense headache; did not speak after admission to hos- 
pital, moaned heavily, head and neck bent stiffly back- 
wards, vomited freely ; died comatose 36 hours after 



admission. Post-mortem revealed acute meningitis and 
profuse serous effusion of the arachnoid on the upper 
anterior surface of the right hemisphere of the enceph- 
alon. The lungs were oodematous and the spleen en- 
larged. 

Case 3. — Pelagius Cremer, aged 39, engaged in out- 
door work, attacked on same day and in same manner 
as preceding case ; died in thirty hours. Post-mortem — 
acute general meningitis, not marked in one locality as 
in case No. 2 ; otlicr organs healthy, except a very much 
enlarged spleen. It was reported that this man had 
repeatedly suffered from intermittent fever. 

Case 4. — Charles Grevcr, aged 24, in hospital with 
periostitis of tibia, suddenly attacked with chills and 
headache on 12th March, 1871 ; vomited freely yel- 
lowish matters; skin cold, pulse not extraordinary. 
Quinine Avas given which was retained, and seemed to 
restrain the vomiting. Under the influence of chloral 
he dozed through the night, occasionally waking up, 
moaning and tossing about restlessly in bed. On the 
13th he was worse, complained of terrible pain in fore- 
head, neck, and back ; the muscles of abdomen became 
rigidly tetanic, and opisthotonos set in. The skin was 
mottled darkly, and there was an indistinctly marked 
purpuric appearance; he had a slight convulsion, and 
passed urine and fteces in bed ; he slept occasionally, 
raved and breathed stertorously, frothing at the mouth. 
Commenced to sink early on the 14th, and died forty- 
seven hours from attack. Post-mortem : Calvarium 
unusually thin, dura mater much congested ; on de- 
taching dura mater the whole surface of encephalon 
was bathed in bloody serum floating small jelly-like 
particles of lymph ; the pons varolii and medulla ob- 
longata were profusely charged with serous effusion ; 
other organs healthy. 

Case 6. — Recover3^ Patrick S., aged 10, residing in 
a detached house near the farm. Deep excavations for 
buildings have been going on in tiie immediate vicinity. 
He Avas suddenly attacked, on February 12, 1871, with 
headache, chills, and vomiting, as in preceding cases. 
On the 13th his breast and face mottled darkly, but not 
spotted; abdominal muscles rigid, neck and spine bent 
backwards, herpetic eruption on face and lips ; this child 
suffered great pain and was delirious at intervals, rolling 
about uneasily in bed, and stretching out his arms ri- 
gidly. About the tenth day the right eye became in- 
flamed, and an opaque effusion appeared in the anterior 
chamber. The pupil was kept well diluted with atro- 
pine, but seemed insensible to light ; he was also a little 
deaf The eflfusion daily became more opaque and solid ; 
the boy suffered severely, continually complaining of his 
head ; but fighting through all the phases of the disease, 
he began to improve about the sixth week, but was 
unable to leave his bed before the expiration of the 
ninth week. The herpetic eruption and the effusion in 
sheath of the optic nerve left no doubt of this being a 
true case of cerebro-spinal meningitis. 

He still resides on the island, and his condition at 
present, one year since his sickness, is as follows : 
Right eye atrophic, vision completely lost, anterior 
synechia, pupillary space contracted, and filled up with 
a lymphic white deposit; partial but apparently perma- 
nent paralysis of right side, throws out the right foot 
and hand with an uncertain motion ; occasionally com- 
plains of headache; hearing not good. 

Case 6. — Recovery. Teresa S., aged 4, sister of 
case No. 5, attacked on Feb. 23, eleven days after, and 
in the same manner as her brother ; opisthotonos ex- 
isted to a degree, swallowed with difficulty ; suffered 
severely with headache, and moaned incessantly ; 
shrieked when her neck or occiput was touched ; when 
lifted by her mother she continued rigidly bent back- 



THE MEDICAL RECORD. 



wards ; the tongue always kept dry and chippy ; the 
Hps and face also spotted with herpes; she was for 
some time deaf while sick, but the eye did not suffer. 
Althoufjh ihis child wa^ an aggravated case, she re- 
covered three weeks before her brother, and she now 
siiows no evidence of any cerebral lesion, being ap- 
parenily quite heallhy. 

During 1870 only four cases of cerebro-spinal me- 
ningitis occurred in the hospital, all resulting in death. 
Shiirtest duration of disease three days. 

During 1871 there were 26 cases treated, of which 
li died: 1 died in eighteen hours from attack; 5 died 
within two d.iys, 3 within ten days, 1 within thirteen 
days, and 4 exceeded this up to eight weeks, the re- 
maining 12 becoming clironic, made a protracted re- 
covery. 

In the month of January, 1872, already two fatal 
cas;;s have occurred: one died in twenty-two hours, and 
the other in eight days. 

There was no peculiarity to be observed in the ages 
of those attacked; the majority were adults, four were 
under ten years of age. 

Of the whole, only four were females. Winter or 
summer did not seem to make any diflerence, the cases 
in each season being about equally divided, except 
that in February, 1871, five cases occurred wiihin a 
few days of each other. 

With the exception of cases 5 and 6, there was little 
or no communication between the parties attacked, the 
cases were scattered through the different buildings of 
the institution. 

Strict attention is paid to the sanitary condition of 
the whole institution, Hospital and Refuge, and no 
local cause could be discovered as the exciting one, 
unless the turning up of fresh ground for the buildings 
i 1 progress might indicate its malarious character. 



men had been exerted to their utmost. Now for my 
plan: 

I place the patient upon a common chair. I pass 
around his body, below the arms, a bmad strong towel, 
the ends of wliich I give to a stout assistant. The next 
step, ami tlie most important of all, is to fiindy fix the 
scapula. Without tins precaution you will Ijc pretty 
sure to fail, pull as hard and as long as you plea.se. To 
fix the scapula I direct one intelligent a'-si-tant to place 
the ball of the hand firmly against the acromion process. 
I then tie a handkerchief around the arm direc'ly above 
tlie condyles, and make in it a loop for my right hand, 
then, with the arm hanging down closely to the body, 
I pull gently and steadily directly downward:*, and, with 
my lelt hand in the axilla, the bone slips ea-ily and 
quickly into place. Now in this dislocation the head of 
the bone lies under and in contact with the neck of 
the scapula, and if by any means you can depress the 
head of the bone to the extent of one-eighth of an inch, 
or even less, there is nothing to prevent your glidini; 
the bone easily into place, and that, too, without injur- 
ing any of the joint structures. I have said that I claim 
this method as exclusively my own. If it has ever been 
practised or recommended by others, I have failed to 
see it. 



THE "ARTERY CONSTRICTOR," WITH 
CASES. 

By S. FLEET SPEIR, M.D., 

BKOOKLYN, N. T. 

(Rcml before the Medical Library and Journal Assuciation, N. Y.) 



A NEW METHOD OF REDUCING A DISLO- 
CATION OF THE HU:\IERUS INTO THE 
AXILLA, WITH REFERENCE TO THE 
ANATOMY OF THE SHOULDER-JOINT. 

Bt E. p. BENNETT, M.D., 

DAXBUBT, CON'S. 

Ix the early part of my professional life, being often 
called upon to reduce this very common dislocation, I 
often experienced great difficulty in accomplishing my 
object, and when I did succeed I often found irrepara- 
ble injury had been done to the structure of the joint, 
and the patient more or less crippled. I carefully 
studied all my surgical works, and carefully examined 
and tried all of the various methods by them advised 
for the reduction of this injury, and finally came to the 
conclusion that they were all radically defective, as 
they did not take into consideration the anatomical 
structure of the joint. It is needless for me to detail 
these various methods, as they are famihar to all, and, 
as I said before, they are all unscientific and defective. 
It does seem as if in most of them the efforts of the sur- 
geon and of his assistants were designed more to tear 
the scapula from its attachments to the chest, and the 
muscles from their attachments to the humerus, than to 
replace the displaced bone. Since I have adopted 
my method, which I call the anatomical method, and 
which, egotistic as it may appear, I claim as exclusively 
my own, I have never failed in a single instance of re- 
ducing this dislocation by the tractive force of one hand, 
and this after all the other methods had been tried and 
failed, and when the united strength of ten or twelve 



' CONS'TRICTION' 



OF THE ASTERIOR TIBIAL AND INTERNAL 
PLANTAR ARTERIES. 



Case I. This is the only case in which there has been 
any accident after the application of the artery con- 
strictor, under my observation; and as a faithful 
record requires the whole truth to be told, I am glad I 
have nothing worse to report. 

On tlie 28th of December, 1870, at the Brooklyn 
City Hospital, Dr. D. E. Kissam, performed amputa- 
tion at the ankle-joint, on a woman aged 30 years, 
for extensive disease of the bones of the foot. The 
patient was etherized, and Pirigoff's operation perform- 
ed. At the invitation of Dr. Kissam, I closed the ante- 
rior tibial artery with the constrictor. This was the 
onl)' arter}' which bled at the time of the operation, and 
it was supposed that the other arteries had been closed 
by the previous disease and inflammation ; however, tl:e 
internal plantar artery looking larger than usual, it was 
thought best to apply the constrictor to it also; which 
was done before closing the wound. In coaptating the 
flaps, it was found tiiat considerable force was neces- 
sary to overcome the resistance of the muscle, and 
adjust the portion of the os calcis (which is left, in 
this operation), to the ends of the tibia and fibula. In 
doing this, Dr. Kissam jiressed very violently upon the 
anterior tibial artery, at the point where it had just 
been constricted, and repeated this pressure several 
times before he was able to adjust the bones. Not- 
withstanding which, there was no bleeding from the 
artery. I was in some doubt as to the propriety of 
leaving the vessel in this condition without reapplying 
the constrictor, in order to replace the invagination of 
the internal and middle coats, which it seemed to me 
must have been turned back, and perhaps the clot dis- 
lodged by this violence ; however, as there was no 
bleeding from the vessel, and all present appearing 
satisfied with the security of the artery, it was left as 



THE MEDICAL RECORD. 



53 



it was, and the wound was closed by silver sutures, 
one of which was passed, as it seemed to me, right 
through the anterior tibial artery (an accident which 
might very easily occur, as there was no guide to the 
artery), and my anxiety for the integrity of the vessel 
was again aroused; slill, no bleeding following, the 
stump was bandaged, and (he patient put to bed. 

At 8 P.M. the same night there was bleeding from 
the stump. Dr. Hamilton, the House Surgeon, found it 
necessary, in order to nri-est the hemorrhage, to open 
the wound. He found the anterior tibial, which had 
been constricted, bleeding; he tied this vessel back of 
the constriction. This, however, did not arrest the 
bleeding, and the external plantar artery was sought 
and tied; this checked the bleeding sufficiently to leave 
it for the night, and Dr. Kissam was notified. I went 
with him to see the patient the next morning. We 
found that there were yet several small vessels which 
continued to bleed. Their texture was such that a 
ligature applied to them cut completely through them, 
and came off at once, — so that it was very difficult to 
check the hemonhage, but by great care we finally 
arrested it. The internal plantar artery, which had 
been closed by the constrictor was sought, and it was 
found to be perfectly closed with a firm clot, no bleed- 
ing having occurred from it. In fact, it was about the 
only vessel in the wound which did not bleed. 

POPLITEAL ANEURISM TREATED BY THE APPLICATION OF 

THE " ARTERY CONSTRICTOR " TO THE FEMORAL 

ARTERY. 

Wm. L , a cachectic mulatto, aged 50 years, 

was admitted to the Brooklyn City Hospital, August 
4, 1871, under care of Dr. D. E. Kissam. In March 
last, while descending a flight of stairs, the patient slip- 
ped and wrenched his left leg, which gave him at the 
time some pain about the knee. The following day 
the pain was so great that he could not bend his knee. 
In a short time the pain diminished, and he could walk 
pretty well. Early in June he noticed a tumor in the 
popliteal region, and at that time he had pain in 
his foot, and a feeling of numbness in his leg and 
foot. Since the first of July, he has had sharp darting 
pains in the tumor. The following is the history as 
taken by Dr. Balch (Resident) : On admission he can 
extend his leg perfectly, but he cannot flex it com- 
pletely ; there is a tumor the size of an orange situated 
in the popliteal space ; palpation gives distinct pulsa- 
tion in the tumor, and a decided thrill ; auscultation 
gives a well-marked " bruit." Pressure on the femoral 
artery stops the pulsation, and the tumor is then easily 
emptied ; stop the pressure, and it immediately refills. 

Auf/unt bth. — Treatment was commenced by the ap- 
plication of Dupuytren's Pad to the femoral arterj' ; at 
the same time flexing the leg on the thigh, a bandage 
was applied from the toes up to the knee. This ap- 
paratus remained on till August 17th, at which time 
the tumor was considerabl}^ harder, but the patient 
would not submit to the apparatus any longer, as he 
said it gave him too much pain. The leg was then 
kept flexed on the thigh till August 2Gth, when, no 
further progress being made towards a cure, Dr. Kis- 
sam invited me to apply the artery constrictor to the 
femoral artery. Dr. Kissam made an incision about 
14- inches long in Scarpa's space, and found the artery 
very superficial. The sheatli of the artery was opened, 
and I applied the artery constrictor to the vessel, and 
immediately all pulsation in the tumor ceased. The 
wound was closed with silver sutures and adhesive 
straps, and picked lint, dipped in a weak solution of 
carbolic acid, placed over all, and the leg enveloped in 
cotton wadding, and the patient put to bed. In the 



evening the temperature of the foot and leg was higher 
than that of the sound limb ; there was verj'' little pain ; 
pulse 92. 

AiKjTist 21th. — Rested pretty well last night; wound 
looks healthy; no pain ; no numbness. 

Aiirjvst 2Sth. — Wound begins to suppurate ; pulse 84 ; 
some fever; complains of numbness; temperature of 
foot good. August 2dth. — No fever; pulse 80 ; tongue a 
little coated ; sutures removed, and wound dressed with 
weak solution of carbolic acid, and adhesive plaster ; 
some suppuration. Avgust 30tJi. — Wound suppurating 
freely ; no union by first intention. September 3d. — Not 
so much suppuration ; Temperature of foot normal. 
Srpiemher Blh. — Wound begins to heal ; removed wad- 
ding from the leg; temperature of the leg normal; 
aneurism smaller. September Wth. — Wound nearly 
healed ; patient looking well ; no pain or numbness. 

September '?.hth . — Wound entirely healed ; patient can 
nearly straighten his leg, can flex and extend his foot 
without any trouble. October 5tJi. — Discharged from 
Hospital, cured. 

The immediate relief from pain which followed the 
application of the constrictor was in marked contrast 
with the great distress and pain attending the treat- 
ment by compression and flexion. 

AMPUTATION OF THE FOREARM WITH APPLICATION OF THE 
" ARTERY CONSTRICTOR." 

Christian S , set. 39, admitted to th.e Brooklyn 

City Hospital August 7, 1871. This patient, while at 
work in his shop, had his wrist caught between two 
wheels, producing a badly-lacerated wound of the dor- 
sal aspect of the liand, compound dislocation of lower 
end of radius, compound fracture of the styloid process 
of ulna, and crushing of the carpal bones. The parts 
above the wrist were uninjured. I saw the patient at 
one P.M. He was then etherized, and I amputated the 
forearm at its lower third, by dorsal and palmar flaps. 
The artery constrictor was applied to the ulnar artery, 
the radial and interosseous arteiies were secured by silk 
ligatures, the flaps broughtjtogether by Avire sutures, and 
dressed with lint soaked in a solution of carb(»lic acid 
and water ; patient put to bed, arm at rest and elevated 
upon a pillow, and an opiate at night. 

Sth. Patient feels very weak (probably due to loss of 
blood before operation) ; pulse 120 ; has pain in stump ; 
ordered an opiate ; vomited after breakfast to-day. dtJi. 
Pulse 110 ; stump looks well ; suppurating where the 
ligatures were applied, no .mppiiration on side where the 
constrictor was used. 10!"/;. Pulee 105, suppuration con- 
fined to the radial side. i2fJi. Feels better ; pulse 100 ; 
sat up in bed to day. 15;!/?. Removed sutures. The 
flaps on the ulnar side of arm have entirely, healed by 
first intention; on radial side suppuration continues. 
17^/;. One of the ligatures came away to-day. 20th. 
Patient went out on pass to day, still suppurating at 
point of radial hgature. This ligature remained in the 
stump until September 29th. October 12fh. The wound 
has entirely healed, and the patient is discharged from 
the hospital, well. 

AMPUTATION OF THE LEG WITH APPLICATION OF THE 
ARTERY CONSTRICTOR. 

Thomas T , fet. 40, was admitted to the Brooklyn 

City Hospital August 17, 1871; service of Dr. D. 
E. Kissam. The Ibllowing history is furnished by Dr. 
Rushmore (Resident): While at work on the East 
River Bridge, the patient's ankle was caught by a coil 
of rope in motion. He was knocked doAvn and his leg 
severely injured. He was brought to the Hospital im- 
mediately, and there was found a lacerated wound on 
the inner side of the tibia, at the lower end. The inter- 



54 



THE MEDICAL RECORD. 



nnl malleolus nl^o fractured. The foot was everted, the 
plantar aspect being parallel with the outer aspect of 
llio iofr. The posttTJor tibial arlory was uninjured; no 
laceration of soft parts above the wound; but little loss 
of Mood. The accident happened about 7 a.m.; at 
10.30 A.M. the patient was anaesthetized, the malleoli dis- 
eected ouf. and the di.slooation reduced by Dr. Ki?8am, 
with a view to save the foot, if possible. The edges of 
the wound were drawn together by wire suture.'*, except 
at the most depending part, where there was left an open- 
ing for the disc!iar;jes. On the 10th the patient's gen- 
eral condition was i)ad ; pulse 13'2, skin hot, foot cold; 
sensation in the foot pood, no di.scharpe from wound; 
inner side of leg and tliigh red, painful, and hot. At 
2.30 P.M., after consultation, it was decided to amputate. 
The patient was etherized, and Dr. Kissam anij)utatcd 
below the knee by anterior and posterior flaps. The 
soft parts on the inner side of leg at the point of ampu- 
tation looked and smell unhealiliy. At the request of 
Dr. Kissam 1 applied the "constrictor" to the anterior 
t.bial and the posterior tibial arteries, which were the 
vessels bleeding, and a!l hemorrhage was immediately 
controlled. The stump wa.s united by wire sutures and 
carbolic-acid dressing applied, patient put to bed and 
ordered supporting and stimulating diet, and opiate at 
night. Pyaemia set in on the 21st; he was delirious 
during tiie night and part of the day. The integument 
on the inner side of the thigh inflamed high up as the 
groin. The stump very unhealtliy, had very little sup- 
puration, which was thin and bad-smelling. Sloughing 
.^pots formed, one over the tubercle of the tibia and ano- 
tiier on external aspect of the thigh. 23d. The flaps 
sloughed, especially on the inner side and in front. 25th. 
Patient died to-day. 

The stump was examined, and the main artery was 
found closed at the point of constriction. A few drops 
of pinkish, thick, bad-smelling matter were found in the 
vessel, but no clot. To the outer side of the larger 
artery was a smaller one, lying close to the main artery. 
This was constricted at a point corresponding to that 
in the larger vessel, aud upon its invaginaled inner 
coats was a clot which perfectly occluded the vessel. 
There had been no hemorrhage from either vessel after 
the operation. The absence of a clot in the larger ves- 
sel seems to show that the invaginaled inner coats of 
the artery were sufficient to perfectly close the ves- 
sel 

From the rough manner in which some of the "con- 
strictors" that I have seen have come from the hands 
of the instrument-makt?rs, it would appear that they 
do not all understand the design of the instrument ; and 
I wish to call attention to the fact that the constrictor 
is not intended to have the effect of an ecraseur, but, 
on the contrary, a blunt and smooth-linished surface 
is very necessary. I would recommend to any one 
who wi.shes to obtain the best result from the use of 
this instrument, to pay special attention to this poiat: 
every part of the surfiice which comes in cont.ict with 
the artery must be polished, and great attention should 
be paid to the edges of the sheath, to see that they are 
,well rounded and smooth, — this is necessary to secure 
the integrity of the external coat, more particularly so 
when it is to be used in the treatment of aneurism. 
Each constrictor should be tried on a piece of chamois- 
skin or a fold of soft paper, or better still, an artery 
from the " subject." If this is done, it can at once be 
determined when the instrument is perfect. Every 
instrument which " cuts through " should be discarded, 
and only those should be accepted which constrict and 
draw the paper, chamois-skin, or the artery, whichever 
one is used, into the sheath, and allows of its being 
pushed out again without breaking or cutting it. At 



the same lime it must permit of a considerable degree 
of constriction, and must not fit too loosely. 

The size of the instrument used um.it be, to a certain 
extent, adapted to the size of the artery to be closed. 
In taking up small arteries in section, as in general 
oj)eration.s, a very small constrictor should be used ; and 
I have found that in such cases it is not nece.s.sary to 
i-olate the vessel from the surrounding tissues before 
constricting it, but they may be taken up with a tenac- 
ulum or forceps, and constricted en masse. In constrict- 
ing large arteries it is best to separa'.e the vessel some- 
wliMt from the other ti-sues. 

The length of time usually required in the application 
of the artery constrictor for completing the clo.sure of a 
vessel varies with the size of the vessel and the j)erfec- 
tion of tlie particular constrictor used. In my own 
cases it has varied from a single minute to several min- 
utes. I usually leave it on the vessel only long enough 
to thoroughly invaginate the inner coats, and then re- 
move it, which would require for the whole operation 
not more than one or two minutes. The work of the 
constrictor may be considered done the moment a 
complete invagination is accomplished. In the case of 
aneurism it may be well to leave it on the vessel a little 
longer, to secure a firm clot in the vessel before remov- 
ing it, or even to control the circulation above the point 
of application. 

No constrictor should be used in an operation until 
it has been tried upon a dead artery or on a piece of 
chamois-skin or fold of soft paper, and its size and 
peculiarities determined by actual trial; any imperfec- 
tion will then be seen, and may be remedied by poUsh- 
ing or filing down, as the case may require. 

As soon as the instrument-makers learn exactly what 
is required of the constrictor, they will, no doubt, be 
able to furnish constrictors which will be perfect in 
every respect when they leave the shop, and then these 
precautionary measures will no longer be necessary. 
Mr. Pfarre, of Tiemann & Co., has a thorough knowl- 
edge of what is wanted in the instrument, and makes 
some very good ones, and Avhen requested, will take 
pains to adapt the constrictor to any sized artery de- 
sired, or he will furnish them in sets of three or four 
instruments of different sizes. 



(DriaimU Cccturcs. 



LECTURES ON OTOLOGY. 

DELIVERED AT THE COLLEGE OF PHYSICIANS AND 30RGE0NS, 
NEW YORK. 

By Prof. H. KNAPP, M.D. 
Repokted by Charles S. Turxbull, m.d., 

AS.SISTAST TO THE NEW YORK OPHTHALMIC AND ACBAL INSTITUTE. 
THE ANATOMY OF THE MEMBRAN.^ TYMPANI. 

Toe memb}-ana ti/wpani, or drum-head, separates the 
external meatus from the tympanic cavity. It is set 
in a groove upon a ridge at the tympanal termination 
of the bony meatus. It is situated obliquely, its outer 
surface being directed downward and forward. 

Upon viewing the membrane, Ave distinguish the fol- 
lowing details:* — In the centre of the upper portion a 
white pointed elevation is conspicuous, — this is caused 
by the short process of the hammer bone; from this a 

^* The lecture was illustrated by drawings on the blackboard, anatomi- 
cal specimens, and microscopic preparations. 



THE MEDICAL KECOED. 



55 



ridge, formed by tlie manubrium mallei, runs downward 
and slitjhtly backward, terminating in a navel-like 
depression called the lonho membraniv hjmpani. 

The area of the drum-head is best divided, according 
to Sir Wilham Wilde, into an inferior, superior, anterior, 
and posterior segments. 

The inferior segment is defined by lines running at 
right angles from tlie umbo forward and backward to 
the periphery. 

The superior segment presents itself as a purse-like, 
flabby projection, the inferior boundary of which runs 
horizontally from behind forward, with the short pro- 
cess lying a little before its centre. On account of its 
flabby pnd folded appearance, the superior segment of 
the membrane is called the flaccid portion, or " 7nem- 
hraiia flaccida ShrapnelUi." As the folds are directed 
from the short process partly backward and partly for- 
Avard, they are distinguished as posterior, and anterior 
folds. 

That part of the membrana tympani lying in front of 
the manubrium mallei, between the anterior-superior 
fold and inferior segment, is called the anterior seg- 
ment, and is generally somewhat depressed. 

In a similar way the p)osterior segment lies between 
the handle of the malleus and the posterior portions of 
the upper and lower segments. 

At the junction of the anterior and inferior segments 
a bright triangular speck, pointing towards the umbo, is 
conspicuous on inspection with the mirror, and is pro- 
duced by tlie pecuUar curvature of the membrane being 
convex from the umbo to the periphery. 

Tlic membrana tympani is of a pearly-gray color, 
somewhat yellowish in the centre, on account of the sur- 
face of the promontory shining through the translucent 
membrane, the centre of which lies much nearer the 
promontoiy than the periphery. It is winter at the peri- 
phery, because there the circular fibres and the connec- 
tive tissue continued from the neighboring parts to tire 
membrane are more abundant than in any other part. 
Upon considering the structure of the membrana tym- 
pani we find it composed of tliree layers, divided as fol- 
lows : first, the cutaneous, containing the dermoid and 
sub-dermoid layers; second, the./?/j/-o».s layer, consisting 
of radiating and circulating fibres; and third, the 
raucous layer, containing the epithelial and sub-epithe- 
lial layers. The fibrous layer is found devoid of both 
blood-vessels and nerves, whilst the two others, being 
continuations externally from the epidermis of the 
meatus, and, internally from the lining mucous mem- 
brane of the tympanum, are supplied with nerves, ves- 
sels, connective tissue, and epithelium. The thinnest 
portions of the membrane are about midway between 
the end of the handle downward and forward in the 
anterior portion, and downward and backward in the 
posterior portion ; and it is in one or other of these po- 
sitions that we generally find a perforation, whether 
caused bj' accident or disease (Wilde). 

The cutaneous layer is composed of all the essential 
elements of the cutis, except glandy, and is made up of 
several layers of epithelium, connective and elastic - 
tissue, well supplied wiih vessels and nerves. The 
sub-dermoid connective tissue is intimately connected 
with the fibrous, and is densest at the periphery of the 
membrane and along the manubrium. A band of 
parallel fibres, two lines in breadth at its origin, descends 
from above downward, and surrounds the manubrium, 
and in it and the peripheral increase of connective 
tissue the vascularity is greatest. 

The fibrous layer is comiposed a) oi a radiating slra.lum 
of fine fibrilte, with connective-tissue corpuscles between 
them, which are spindle-shaped in their longitudinal 
section, and round, with three or more offsets, in the 



transverse section, being a nucleated system of nutiitive 
canals, like that of the corneal substance; b) the tendi- 
nous ring, which is situated near the insertion of the 
membrane into the groove of the tympanic ring, consists 
of irregularly interwoven fibres of connective tissue, and 
belongs to both the radiating and circular strata; c) the 
circular stratum, which, however, does not commence in 
the immediate vicinity of the tympanic ring, is thickest 
near the tendinous ring, and becomes thinner as it ap- 
proaches the manubrium. Gruber has described fibres 
descending like those of the sub-dermoid layer. 

The mucous layer on the inner surface of the mem- 
brana tympani is a part of the mucous membrane 
lining the tympanic cavity, and is abundantly supplied 
with vessels, but scantily with nerves. Its epithelium 
consists of one layer of polygonal cells, which are not 
ciliated. Gruber describes a dendritic, or dendroid fibrous 
formation, Avhich begins in the fibrous layer, with a 
broad base at the lower and posterior part of the 
periphery, running obliquely upward toward the handle, 
and lying with its upper offsets near the sub-mucous 
layer. It is identic with the fibrous layer, which lies 
between the circular fibres and the epithelium of the 
inner side, described more recently, in Strieker's Histol- 
ogy, by J. Kessel. It is densest in the centre of the 
membrane around the handle, and divides into numerous 
branches which communicate with one another, and in- 
sert themselves finally into the tendinous ring at the 
periphery. Some of these branches penetrate the layer 
of circular fibres, and either terminate there or return 
in their further cour.se on the posterior surface of the 
fibrous stratum. This membrane, of a more or less 
trabeculated appearance, constitutes the sub-mucous 
stratum. 

On the inner surface of the mucous membrane, and 
especially upon the trabeculse of the sub-mucous 
stratum, are found numerous villi, which have the 
structure of the mucous membrane, and contain in their 
axes a loop of a blood-vessel, and so constitute vascular 
papillae. 

Gruber represents the connection between the 
handle and membrane as joint- like, and asserts that in 
many specimens the handle shows at this place a thin 
layer of cartilage upon its surfiice. Facing the handle 
and short process, a cartilaginous formation is imbedded 
in the substance of the membrana tympani, connected 
with the handle very loosely on its surface by delicate 
fibres, but more densely by a kind of capsule on its 
edges. The manubrium is, however, more densely con- 
nected with the cartilage, and he asserts that he has 
found epithelial cells on the opposing surfaces of the 
short process and cartilage, and that a synovia-like 
fluid is found between the bones and the described for- 
mation of cartilage (page 63 of his monograph on the 
membrana tympani). Moos, Prussak, and others deny 
this joint-like union between the membrana tympani 
and the hammer bone, the fibres of the membrane 
proper inserting themselves directly into the periosteum 
or perichondrium. 

The blood-vessels of tliC membrana tympani are de- 
rived externally from the arteriaauricularis profunda — a 
little branch of the internal maxillary. In its course it 
descends from the upper wall, runs along the manu- 
brium, and divides into radiating branches, which 
anastomose with those of the tympanic ring at its 
periphery. The capillaries collect into two venous 
branches, which run alongside of the artery. Prussak 
and J. Kessel described two venous plexuses which re- 
ceive the blood from the outer layer of the membrana 
tympani, the one running along the handle, and the 
other in a circular direction around the periphery. 

The internal vessels are derived from those of the 



56 



THE MEDICAL RECORD. 



mucous membrane of the tympanum, " artoria tympnn- 
ioa," till" ramifications of whicli arc numerous, forming 
a den^e net-work of capillaries. The fibrous layer, or , 
membrana propria, was formerly considered as having 
neither ve^si.ds nor nerve?, but J. Kessel says that 
it is pervaded by a net-work of capillaries connecting 
the blood-vessela of the outer layer wilii those of the 
the inner layer. The capillaries of thn membrana tym- 
pani have an arrangement similar to tliat of tlie blood- 
vessels: three strata, the one belonging to tlio cuta- 
neous, the next to the mucous layer of the membrane, 
and a third connecting the two witli each other by 
capillaries running through the membrana propria (J. 
Kessel). 

The nerves of the membrana lympani are supplied 
externally from the tympanic nerve — a branch of thfi 
" tempero-auricular," derived from the third branch of 
the trigeminus. It descend sfrom the roof of the 
meatus and courses brandling in the same direction as 
the artery. According to Kessel, there are branches 
running from the outer layer into the fibrous layer, in 
which a part of them remain, dividing into more mi- 
nute branches or twig-:; while another })art pass tlirough 
it and communicate with the nerves of the mucou> lay- 
er. Those found internally are scanty, and are trans- 
parent, without medullar}' sheaths. 

WOUNDS AND INJURIES OK THE MEMBn.\NA TYMl'ANI. 

The causes tending to injure this delicate membrane 
are quite numerous — penetrating instruments and 
foreign bodies, by external force or violence, such 
as fracture of the temporal bone, blows upon the side of 
the head, falls, etc.; sudden concussions of air, as in 
pertussis, loud, sharp reports from heavy pieces of 
artillery. 

Gruber says that the membrana tympani bears verv 
high degrees of pressure (from four to five atmosplicres) 
Without bursting. He thinks that only in membranes 
previously diseased a rupture is liable to occur by sud- 
den increase of atmospheric pressure. The bleedino' in 
pertussis and other diseases is not always a symptom of 
rupture of the membrane, as also the blood-vessels of 
the conjunctiva and other membranes are very apt to 
burst in this disease. 

The si/)))p'oms are : — 

Pain, mostly of an inter.se character, at the moment 
of the rupture. Sometimes, however, no pain is felt. 

Fainting, which may be repeated during the next 
twtnty-four hours. 

Convulsion.'} are very rare. 

A loud noi.'ie or crash at the moment of the rupture, 
caused by the fearing of tb.e fibres or the sudden pres- 
sure upon tlie labyrinth. The noise persists for some 
days, in most cases, but gradually dmiinishing in in- 
tensity. 

The hearing is impaired in ©very case where the mem- 
brana tympani was normal before the accident, but it 
may be improved in cases of diseased membrana tym- 
pani, for then the membrane is no longer a septum 
barring the entrance to the waves of sound, the latter 
having immediate access to the stapes, and the mem- 
brana tympani secundaria. 

Jlyperacusis, or Sonophohia, in rare cases: some 
noises or tones being very disagreeable. 

Los>i of the faculty of determining the direction of sound. 
Tliis symptom is not constant, and soon disappears. 

Extravasation, covering the rent in an otherwise nor- 
mal membrane. 

A rent orjissure of oval or linear shape; at times the 
dermoid and radiating layers retract more than the 
inner layers, and a wound with terraced edges is 
produced. 



The prognosis of wounds and injuries to the mem- 
brane is generally favorable. Wilde, however, ob- 
serves : — '' It is remarkable that, while we experience 
the greatest difficulty in keeping open a perforation 
made with a surgical instrument, accidental openings 
seldom close." This serves as an argviment in favor 
of Gruber's statement, that the memi)rane was gen- 
erally diseased before the perforation occurred. 

The treatment is simple and can be readily given : 
Do not syringe, but let the ear alone. 

Cleanse the meatus with cotton, and insert into it a 
light plug of cotton or wool to protect the membrane. 

The healing in most ca~es takes place rapidly and 
without inflammation. If the latter ensues, the symp- 
toms are those of myringitis. 



profircso of iHctilcal Science. 



PnoTOPnoBiA IN Sightless Eyes. — A writer in the 
Br. Med. Journal cites three or four cases in which 
marked j'hotophobia remained after destruction of the 
eyeball, following injuries, in which favorable prognos- 
tications had been given by physicians in attendance ; 
their opinions that sight would remain after inflamma- 
tion had been subdued having been wrongly based 
upon such persistent sensitiveness to light. 

Lead Poisoning from Snuff. — Dr. Garrod reports an 
interesting case of this nature, which had been caused 
by snuflT which had been packed in lead, and refers to 
several other cases of similar character. It appears 
that when moist snuflF is enclosed in leaden cases, and 
especially when subjected to the action of heat in 
tropical' climates, it becomes intensely poisonous from 
impregnation with the metal. He explains this as fol- 
lows: — Tlie moisture of the snufl', containing its solu- 
ble salts, is evaporated and condensed on the sides of 
the leaden case, upon which it slowly acts ; and the 
lead salts, thus brought into solution, gradually impreg- 
nate the mass. 

Albuminuric Retinitis. — Mr. Swauzy, speaking of 
this aflFection, says {Med. Press and Circular) : '' Every 
one who has busied himself specially with diseases 
of the eye must have had frequent occasion to diagnos- 
ticate Bright's disease by the opthalmoscopic appear- 
ances, while, as yet, there were no other prominent 
symptoms ;" the disturbance of the function of the eye 
being the first thing which would lead the patient to 
seek medical advice. He thinks the physician who 
takes the trouble to learn the use of this instrument 
will be abundantly paid, during his first five years' prac- 
tice, in his ability to use it as a means of diagnosis in 
this afl*ection alone. He says that " as a general rule, 
in those cases where the eye gives the first indication 
of the presence of Bright's disease, the progress of the 
latter is fiom that time very rapid. From three to six 
or eight weeks is commonly long enough to biing the 
case to a fatal termination, and it is rare for these 
patients to live for three or lour months after the sight 
has become aflfected." 

Treatjient of Favus avithout EriLAXiON. — Prof. 
Enrico de Renzi has undertaken to treat this affection 
without removal of the hairs, by the following method : 
First, the nature of the disease having been determined 
by the aid of the microscope, the hair is cut closely and 
the head rubbed with an ointment consisting of one- 
tenth part of phenate of soda. After a very short 
course of treatment the parasitic growth is seen to 
lose its transparency, become granular, and at last is 



1 



THE MEDICAL RECORD. 



57 



detected, by aid of a magnifying glass, reduced to frag- 
ments around the roots of the hairs. Under the con- 
tinuance of this treatment it completely disappears, 
never to return except as a result of a new engrafting 
of tlie parasite. — Lyon Medical. 

Gelsemium in Irritable Bladder. — Dr. W. Scott 
Hill, of Augusta, Maine {Am. Jouru. Med. Sciences) re- 
lates five cases of irritable bladder wliicli were relieved 
by the administration of Tilden's fluid extract of gel- 
semium. 

Electrotherapy. — J. W. Holland, M.D., Prof. Chem., 
Univ. Louisville (.1???. Practitioner), speaks of a case of 
" nervous deafness," due to a sudden but enduring 
apathy of the auditory oerve, in a patient aged forty- 
one, which was considerably improved by the feeblest 
current from a volta-faradic coil, after a sitting of five 
minutes' length. The revival of the auditory nerves 
gained fresh force from each electrical sitting, and he 
presumes that, as five applications have accomplished 
so much, by continued excitation the torpor may even- 
tually be entirely removed. 

Uterine Cloth Tents. — In a reprint from the Atlan- 
ta Medical and Surgical Journal, Dr. V. H. Taliaferro, 
of Columbus, Georgia, gives some practical observations 
upon medication by the use of uterine cloth tents in 
diseases of the body and cavity of the uterus, with ac- 
companying wood-cuts. They are designed as a safe, 
read}', and thorough means of intra-uterine medication, 
dilatation in uterine cervical structures, and of prepara- 
tion of the uterus for intra-uterine injections. That 
they accomplish these objects witli greater safety and 
thoroughness than any means heretofore employed he 
is fully convinced. 

Knee-joint Amputations. — Dr. W. H. Hawkins, of 
Rocky Comfort, Arkansas (Proceedings Arh. Med. As- 
soc), presents two successful cases of this amputation, 
and notes the excellent treatises upon this subject by 
Drs. Markoe and J. H. Brinton. In general, he be- 
lieves that knee-joint amputations compare favorably 
with amputations of the leg at any point above the 
knee, and as economy in preserving as much of a dis- 
eased or injured member as possible is always desira- 
ble, this operation possesses decidedly the advantage in 
this particular. 

In these two cases the antero-posterior flap, with 
retention of the patella, was adopted, though the con- 
dyles were shaved off. The shaving off of the condyles 
he regards as an unnecessary proceeding, and, in future 
operations, he will follow Dr. Stephen Smith's method, 
as detailed in the Am. Journ. Med. Sciences, 1870. It 
admits of a more thorough drainage, and places the 
cicatrix in a position least liable to be pressed by an 
artificial limb. 

A Plan for Facilitating the Reduction of Stran- 
gulated Inguinal Hernia by Taxis. — A correspond- 
ent of the British Med. Jour, calls attention to a 
method recommended by Baron Sentin to be followed 
in this operation. The patient is to be placed on the 
back, with the hips well raised, and in case the hernial 
tumor is not reducible by the ordinary manipulation, 
the surgeon is to pass his index finger up into the 
ring, if possible to the outer side of the gut. After 
crowding the point of the finger past the column of 
the ring, strong and constant pressure is made, until 
the fibres of the ligament give way, or the opening 
is perceptibly enlarged, when it will be found that the 
intestine can be returned easily to the abdomen by the 
usual effort. The conditions which contraindicate a 
resort to this procedure are : — 



1. The fact of the hernia being old and irreducible. 

2. The presence of the constriction at the inner 
ring — the external ring being too small, and the canal 
too long, to admit the finger. 

3. The existence of general symptoms of grangrene 
of the intestine. 

Tanacetic Acid as a Substitute for Santonine. — 
This acid is prepai-ed by distillation of ihe heads of 
common tansy {tanacetum vulgare). The filtered resi- 
due is evaporated to the consistency of honey, treated 
with lime and animal charcoal, dried, and then dis- 
solved in water acidulated with hydrochloric and 
acetic acids. Tiie tanacetic acid is deposited in colored 
crystals, which are purified by repeated washings with 
distilled water. It has a sharp, bitter taste, and is in- 
soluble in water, but soluble in alcohol and ether. 
Nearly all its salts are crystallizable. As a vermifuge, 
it operates in tlie same doses as santonine. — Med. Press 
and Circular. 

Hysterical Ischuria. — M. Charcot reported to the 
Societe de Biologic (Lyon Mcdicale) a curious case (if 
true — Ed.) of this affection occurring in a woman 43 
years old, who had suftered for several years with 
hemiplegia with contractured limbs, and who had an 
almost complete supi>ression of urine supplemented by 
constant vomiting. The total quantity of urine col- 
lected with great care by aid of a catheter was, from 
the 8th to the 14th of July, but 4G grammes; from the 
16th to the 22d of July, 33 grammes; and from the 
24th to the 30th of the same month, 21 grammes. 

The vomited matter, analyzed by M. Grehaut, fur- 
nished urea in quantities very nearly proportionate to 
the amount which should have been normally dis- 
charged by the urinary passages. 

Effects of Crude Paraffine on the Skin. — An af- 
fection of the hair-follicles is described by Dr. Alex. 
Ogston in the Edinburgh Med. Journal (Dec), which is 
caused by prolonged exposure of the skin to the action 
of the oily matter contained in this substance: the 
result being an eruption of nodules and pimples on the 
skin so exposed, speedily breaking out on those who 
are for the first time engaged in handhng it, lasting for 
a few weeks or months, and then generally diminishing 
or disappearing. In the few cases in which it becomes 
chronic a change of employment is a necessity. The 
mark of difference between the acute and chronic forms 
is the presence of inflammatory action in the former. 
A minute examination of the skin in the former variety 
shows bright-red nodules which are hard to the touch, 
tender onpressure, vaiying little in size,which is about 
equal to that of a grain of barley, are of a rounded 
form, and consist eacli of a single hair-fohicle with the 
surrounding parts red and inflamed. A hair emerges 
from the summit of one of these follicles, the orifice 
of which is enlarged to the size of a pinhole in a card. 
This dilatation extends to the deeper part of the follicle, 
which is filled with a dry and friable mass of epithelial 
scales and dirt. In the chronic form the hairs have 
been atrophied and destroyed by pressure, and the skin 
affected presents the open mouths of these distended 
follicles, sometimes large enough to admit the end of a 
probe, the skin including those raised patches of erup- 
tion being of natural color. 

The modus operandi of the crude paraffine in pro- 
ducing this eruption seem.s to be that the oily matters 
in the shale called "blae oil," is irritating to the skin; 
and, coming continually in contact with the epidermis, 
soaks into the hair-follicles, where it causes an increased 
growth of epithelium, which is not counterbalanced by 
increased expulsion of the scales, owing to the fatty 



58 



THE MEDICAL RECORD. 



matter from the sebaceous glands being dissolved out 
and rohioved liy tlic "blae oil," tlius leaviiif,' tlio brittle 
mass of fpitholiuin to plug "P tlic follicles. I'arts of 
the skin not supplied witli hair-foUiclos are not aflocted. 
A suprosKn Cause of Heart Disease. — Dr. Moinet 
(Kdinbiirgk Mtd. Jour.) offers the theory that ili-ease 
of the heart and aorta are produced in some instances 
by the weiglit of the heart wlien the subject is in the 
erect posture, producing lle.xion of tlie arch of the aorttn, 
rendering its curve more acute, and thus oQcring an 
increased resistance to the current of blood; corre- 
sponding hy[)ertrophy of the heart being tlie first no- 
t:ceable result. This bending of the aorta tends also, 
he thinks, to weaken its coats, thus laying (he founda- 
tion for aneurism at the commencement of its arch, 
where it is so often found. He thinks also that soldiers, 
on account of the confinement of their chests by their 
acoutrements and uniform, and the active and prolonged 
exercise of their upper extremities ■while tliey are so 
confined, are particularly liable to disease of the lieart 
arising from this cause. 

Spirits of Turpentine in Phosphorous Poisoning. — 
The Bulletin of Hie Royal Acad, of Med. of Bekjium 
(No. 9) contains a long article by M. Rommelaere on 
this subject, in the course of which numbers of suc- 
cessfully treated cases are detailed, the amount of tur- 
pentine taken averaging about a drachm daily. 

Cutting Microscopic Sections of Eyks. — Edward 
Curtis, M.D., of New York (Tra?is. Am. Ophthal. Sac), 
devised an apparatus for cutting microscopic sections, 
when needed, of an entire eye. In preparing the tissue 
and cutting the sections there are one or two points 
which it is necessary to observe iu order to get the 
best results. Supposing the object to be a morbid eye, 
this must, immediately after enucleation, be put into 
Muller's fluid — bichromate of jjotash, 75 grains; sul- 
phate of soda, 25 grains ; water, 6 fluid ounces — and 
there left for at least three weeks. It is then cut open 
with a sharp knife or razor, and the halves soaked in 
water to remove the bichromate. Such portion as is 
intended for cutting in the section-cutter is then to be 
further hardened in alcohol. When ready for cutting, 
the piece is transferred to light-colored oil of cloves, 
where it is allowed to stay froirf half an hour to several 
hours — until thoroughly impregnated with the oil. 
The piece is then to be imbedded for cutting. For 
this purpose the following menstruum is recommended : 
one part of oil of turpentine or benzine to twelve or 
sixteen of parafline. 

The section-cutters and accessories can be obtained 
of the makers, Hawkins and Wale, of the Stevens 
Institute of Technology, Hoboken, New Jersey. 

General Syphilitic Inflammation of the Eye. — Dr. 
Francis Delafield, of New York ( Trans. Am. Ophih. Sac.), 
says that the iris and choroid are the portions of the 
eye which are most frequently attacked after the intro- 
duction of the syphilitic virus in the system. In rare 
cases, however, the inflammation becomes general; 
iris, choroid, ciliary bod}^, retina, sclera, , and cornea 
are involved, and the produclion of new cells is so 
great that staphylomatous tumors of large size are 
formed. The literature of such cases is scanty. Arlt 
describes two cases of anterior staphyloma produced 
by syphilitic new growths from the edge of the iris 
and ciliary body; but no anatomical examination of 
the eyes was made. 

Von Hippel gives a full description of a case in 
which the iris, choroid, sclera, cornea, and retina were 
involved, and a large staphyloma formed. 

Two cases of this character have come under the 
observation of Dr. Delafield, which are published. 



Functional Trouble of the Eye. — Dr. Henry D. 

Noycs, of New York (Trans. Am. Ophthal. Sac), gives a 
scheme to aid in examining and recording cases of 
functional trouble of the eye. This printed form he 
has used for .several months past, and finds very useful 
to insure regularity and completeness in llie examina- 
tion, and for convenience in preserving notes. At the 
date of report lie had kept notes of one hundred cases 
by this method. 

Tliis author, in another article, also exhibited an 
ingenious apparatus for testing the perception of color. 

The Determination of Astigmatism. — An additional 
method for the determination of astigmatism is record- 
ed by Dr. George Strawbridge, of Philadelphia (I'rans. 
Am. OpJiilial. Soc), which has* these advantages: — 1st. 
Simplicity. 2d. Accuracy, which results from the ex- 
treme delicacy of the test formed by illuminated bar. 
3d. The great saving of time. 4th. This method allows 
of examination being made entirely independent of 
daylight, and so obviating any inconvenience arising 
from defective illumination found in cloudy weather, 
etc. 

Dentigerous Cysts. — In an essay to which was 
awarded the first prize of the Boylston Medical So- 
ciety for 1871. by W. P. Bolles, M.D. (Boston Med. 
and Surg. Joicrmd). it seems that the sexes are nearly 
equally liable. Of 23 cases, 11 were males, and 12 
females. The number of upper and lower leeth af- 
fected is also equal. The majority of the cases oc- 
curred between the ages of 10 and 40; 1 to 10, one 
case ; 10 to 20, nine ; 20 to 30, nine ; 30 to 40, three ; 
40 to 50, none ; 50 to 70, three. Contrary to the usual 
statement, but as might be expected from their posi- 
tion in the jaw, the lower third molars are the teeth 
most frequently encysted, and second to these come 
the upper canines. In the appendix, the writer gives 
a synopsis of all the accessible cases (29), with the 
sources whence obtained. 

CoLLEs' Fracture simultaneous in both Arms. — 
A case of this character is published by T. Curtis 
Smith, M.D., Middleport, Ohio, in the Cin. Lancet and 
Observer. The radius of the right arm was fractured 
at three-fourths of an inch above the wrist-joint, that 
of the left at one inch above the joint. These fractures 
were successfully treated by two pistol-shaped sphnts 
applied to each arm, after removing the deformity by 
extension. At the date of publication the union was 
firm, and no deformity can be observed in either arm. 
The patient was a boy, aged 10 years, who, while 
climbing, was precipitated from a height of fourteen 
feet to the ground ; his weight was received on the 
palms of the extended hands. 

In this case motion is as complete as before the oc- 
currence of the accident. Dr. Smith affirms that if 
due care is used, deformity will not often follow the 
treatment by use of two pistol-shaped splints (!). 

Transfusion of Blood. — Carl Proegler, M.D., of Au- 
rora, Illinois, late Surgeon German Army (Chicago • 
Med. Journal), records four successful cases of transfu- 
sion of blood. The patients were French soldiers, who 
were wounded in the streets and before Paris. The 
indications for transfusion in these cases were : — 1st. 
Where amputation had been delayed for some reason, 
with but little chance for the patient, but where the 
latter insisted upon an operation. 2d. Re-amputation 
or resection on account of pyaemia or extreme hemor- I 
rhage, either on account of dangerous after-bleeding, J 
general debility, or a hemorrhagic diathesis. 3d. Ex- 
treme prostration on account of shock, and where life 
seems to be in imminent danger. The amount to be 



THE MEDICAL RECORD. 



59 



injected varies according to circumstances, but it should 
never exceed sixteen ounces. Care should be taken not 
to force air into the veins, ns collapse is liable to follow. 
Chronic IIvpertropiiy of the Lips. — Dr. R. W. 
Taylor, Surg, to N. Y. Dispensary (Afed. World), calls 
attention, with ca-e, to a form of hypertrophy of the 
lips, in which the inflammation begins in its connective 
tissue framework, and whicli produces a permanent 
augmentation in its size, and in wliich the skin and 
mucous membrane are not involved. He observes 
that there are five forms of chronic hypertrophy of the 
lips due to change in the deep structures: — Tlie first 
due to cell-infiltration into tlio corium and papilla;; 
the second, to an increased development of tlae con- 
nective-tissue stratum; the third, to a hypertrophy of 
the mucous follicles and the submucous connective 
tissue ; the fourth, to angiomatous tumors, either ar- 
terial or venous ; and the lifih due to lymph-angioma- 
tous tumors. 

Typhoid Fever with Capillary Bronchitis. — In 

this complication, when tliere is typhoid depression, 
wandering of the mind and bronchial tightness. Dr. N. 
S. Davis, of Chicago, 111. (Med. Examiner), recom- 
mends the internal administration of chloroform, ac- 
cording to the subjoined formula: — IJ. Chloroform, 
3 iij. ; acacife, 3 vj. ; sacchari, 3 vj. ; aquae, § vj. M. 
Dose, a tablespoonful every four hours, alternately 
with other medicine. 

Epulis and Myeloid Tumors of the Jaw. — James 
Tyson, M.D., Lecturer on Microscopy in the Univ. of 
7 exm.. {Dental Times), explains the microscopic points of 
diflference in the characters of these tumors, with a 
view to a completeness of our knowledge of their nat- 
ural history. Epulis tends to occur other than singly ; 
it is, however, a growth of all ages, though there are 
those who have claimed that it also belongs to yoiith. 
Prof. S. D. Gross, on the other hand, in a recent clin- 
ical lecture, said that he had never before met with a 
growth of this kind at so early an age as seven years. 
It is usually a tumor of slow growth, and differing from 
myeloid in this respect; it is often painful; patients 
afflicted with it suffering much from toothache. Again, 
epulis is often partially osseous, frequently containing 
spicula of bone in its centre, detached from the surface 
of the bone. It recurs under the same circumstances 
with myeloid, that is, when all parts have not been 
completely extirpated, though perhaps less frequently 
than the former. It is generally lobulated, as myeloid 
tumor in the same situation, but its structure is firmer. 
It is tougher and more elastic, owing to its fibrous 
structure. On section of myeloid tumors, more decided 
characteristics are noticed, which may be recognizable 
by the naked eye. The cut surfaces are "smooth, uni- 
form, compact, shining, succulent, with a yellowish, not 
a creamy fluid; " presenting "blotches of dark or livid 
crimson, or of a brownish or a brighter blood-color, or 
of a pale pink, or all of these tints mingled on the 
grayish-white or greenish basis-color." Epulis on sec- 
tion is uniform, firm, white and shining, presenting 
often in its interior the spicula to which allusion has 
been already made. Before operation it is not easy to 
decide whether a tumor is epulis or myeloid, and 
though appearances on section are more characteristic, 
they do not become available for diagnosis. As a mat- 
ter of prognosis it is not of paramount importance that 
the exact nature of the tumor be known before opera- 
tion, supposing it one of these two forms, as neither is 
apt to return if thorovgJihj removed. Recurrence of 
each occasionally takes place, and it is somewhat more 
frequent in the case of myeloid ; the periosteum should 
in all instances be scraped after operation. As the only 



certain means of relief, Prof Gross recommends " ex- 
cision of the piece of bone to which it is attached." 

Fever Mixture. — The value of aconite in allaying 
fevers is apparently not so completely recognized as it 
should be ; and having found the following formulas very 
beneficial iu allaying fever, and in controlling it when 
not dependent upon a deep-seated cause, Prof. Horatio 
C. Wood, Jr., M.D., Philadelphia, editor o^ JVeiu Reine- 
dies, publishes the following : Take of Tincture of aconite 
root, gtt. xxiv. ; Sweet spirits of nitre, ffij.; Solution 
(or mixture) of citrate of potash, f 3 iv. Mix. S. Table- 
spoonful every one, two, or three hours. Q''his formula, 
containing two drops of the tincture of aconite root to 
the dose, should be given cautiously, and every hour 
only in urgent ca=es which can be carefully watched. 
Many women will scarcely bear it given every two 
hours. The following combination is more generally 
ap[)licable and safer: Take of Tincture of aconite root, 
gtt. xij. ; Sweet spirit of nitre, f | ij. ; Solution (or mix- 
ture) of citrate of potash, fsiij. Mix. S. Tablespoonful 
every one or two hours. 

Where there is much restlessness with the fever the 
following formula is recommended : Take of Tincture of 
aconite root, gtt. xij. ; Sweet spirit of nitre, Comp. spirit 
of nitre, ila. f 3 iss. ; Camphor water, f§iij.; Morphia 
sulph., gr. ss. Mix. S. Tablespoonful every one or 
two hours. 

The Use of Sewing-Machines. — Dr. A. H. Nichols, 
in the third annual report of the Mass. Board of Health 
(Boston Med. and Surg. Journ.), presents a full exhibit 
of the effects on health of the use of sewing-machines 
moved by foot power, based on personal investigation 
and returns from a large number of correspondents, 
from which it) is evident that most women cannot 
make continuous use of the common pedal for any con- 
siderable time without suflering from general debihty 
and various local disturbances. These evils may be 
prevented by the substitution of steam or foot power 
in large establishments, or by the use of electro-mag- 
netic power, or by the use of improved pedals, which 
greatly reduce the required movement of the feet and 
legs of the operator. 

Pitting in Small-Pox. — W. C. Coleman, M. D. 
(Drug. Circ. and Chem. Gazette), recommends the fol- 
lowing, to prevent pitting in small-pox, as the result 
of his own observation: First, prevent suppuration as 
far as possible; second, allay irritation; and third, keep 
the scabs off. To accomplish the first and second, rup- 
ture the pocks thoroughly while in the vesicular stage, 
and apply carbolic acid and mucilage of gum acacia, 
mixing one part of the former to eight of the latter, 
and apply freely with a hair pencil. To keep the scabs 
soft, use olive or sweet oil freely. Continue the mucil- 
age and acid as long as the irritation lasts, and there 
need be no fears of the oil interfering in any way, 
provided the mucilage is made quite thin. 

Hypodermic Injections of Corrosive Sublimate. — 
In a practical paper " On the Treatment of Syphilis by 
Hypodermic Injections of Corrosive Sublimate," by 
Dr. R. W. Taylor, of New York (Med. Gazette), his views 
are given, in concluding, in eighteen aphorisms, which 
are thus summed up : While in dispensary and hospital 
practice the injections may be frequently given, in pri- 
vate practice the smallness of a patient's means may 
often be an obstacle in the way of the continuance of 
treatment. That, while in some cases the treatment 
may be useful by reason of its rapid action, and in 
others for the smallness of the dose, the inconveniences 
which it produces, the objections of the patients, and 
the presenee of lesions which contraindicate its use, 
confine its sjjhere of usefulness to very narrow limits. 



60 



THE MEDICAL RECORD. 



Cakdonatk ok Soda. — A new process for tlio produc- 
tion of ciulxmiiU- of soda lias lioen iiivi-iitcd by M. 
Swftger. IJy tlie joint aid of highly siipcrliiMtid Htoatii 
and red lieat, he decomposes the duiilile ciiloride of 
aluiiiituiiii and sodium, previously fused, liiiis lormint; 
alumiii ite of soda and liydrochloric acid. The latter is 
condensed; the former, treated with earl)onic acid, 
yields carbonate of soda and alumina. 

Lkucin and Tvrosik. — According to James Tyson, 
M.I)., Prof Phys. and Histology in Pcnn. Collepo Den- 
tul Surgery {.[m. Joiiin. Mrd. Sciences), these organic 
nitrogenous substances found in the solids and fluids 
of the economy \n a number of morbid states, have only 
a marked significance when present in the urine in 
connection wiih .symptLiins pointing to derangement of 
the hepatic function. Under these circumstances they 
are of grave import, indicating destructive diseases of 
tliis organ which have hcrctolore invariably terminated 
fatally. They do not necessarily indicate acute yellow 
atrophy alone, but may attend any affection of the 
liver in which there is permanent disorganization of its 
])arenehymatous structure, even if it extend over a 
period of sevend months. It does not appear to be 
present in the urine in cases of liver disease which are 
perhaps years in completing their course, as in certain 
instances of cirrhosi-^, and simple fatty degeneration. 
When there is deficiency of urea in the urine thus con- 
taining leucin and tijrosin, the mode of death usual 
under these circumstances (coma or convulsions) can 
only be rationally explained on the supposition that 
there exists a condition analogous to uia;mic poisoning. 
or identical with it. 

Prof Tys^n presents in full the chemical and 
microscopic.d cliaracters, tests, and drawings of these 
substances ; also tlic modes of obtaining leucin and 
tyrosin from animal fluids and tissues suspected to con- 
tain them. 

H.«xroPTYSis IK Consumptive Patiknts. — D. Francis 
Condie, !M.D., of Phila. (.4m. Journ. Med. Sciences), says 
that it is true that the deposition of tubercular matter 
in the lungs may be preceded and accompanied by 
luttmoptysis, but by no means so generally as to war- 
rant iLs being ranked as among the premonitory, much 
less as a diai:noslic symptom of tubercular phthisis. 
Of 369 cases of tubercular consumption, very full notes 
of which he has kept, hajmoptysis occurred in 87 — that 
is, about 24 per cent. In 282 of the cases it neither 
l>receded nor was present throughout the attack. The 
absence, therefore, of haemoptysis is not to be received 
in any case as an indication of the absence of pulmo- 
nary tubercles, nor can the occurrence of pulmonary 
hemorrhage be received as an indication of a future or 
present tuberculosis of the lungs. 

In the 87 cases of consumption in which pulmonary 
hemorrhage occurred under his observation, the he- 
morrhage preceded in 40 the first symptom of the 
deposit of tubercular matter some considerable time — 
say two, three, five, six, or even twelve months; in 
some cases, however, it preceded the indications of tu- 
berculosis only a few days ; in other.s, again, it occurred 
at the very onset, so far as he -was enabled to judge, of 
the tubercular deposit. In 29 cases the hemorrhage 
occurred at different periods durin? the progress of the 
disease, and in its latter stage in 18 cases in which the 
presence of cavities in the lungs was detected upon 
auscultation. 

Fr,ATULEKT Dyspepsia. — The late Dr. Trousseau, of 
Paris (New Sydenham Society's translation), in this 
form of dyspepsia, administered alkaline preparations 
for a few consecutive days, followed by the administra- 



tion of bittern. For five or six days, at the beginning 
of (he two principal mealf, and on retiring at night, the 
following j)owder is u.sefnl : Magnesia, chalk, bicarbo- 
nate of soda, 4 toOgrs. each, mixed immediately before 
taken in a fourth of a tumbler of waU'r. This to be 
lollowcd by I lie employment of quassia. In the morn- 
ing fasting, ami atmi<lilay. at an equal interval between 
the two principal meals, the i)atient ought to drink a 
cup of the infusion of qua.ssia, prepared by leaving a 
teacupful of cold water for 1/i or 20 miimtes in a goblet 
made of this wood ; or, which is much better, by macer- 
ating two granunes cf quassia .shavings in cold water 
from four to six hours. In these cases wine of cinchona 
IS akso indicated. It ought to be given either immedi- 
ately alter meal-, or immediately after the patient has 
taken a small quantity of food, in order to prevent the 
pain in the stomach which is aj)t to be excited when 
taken fasting. 

Urktiihai, PAtns. — Prof. Andrews, ofMercy Hospital, 
Chicago, III. (Med. Kxaminer), in cases of gonorrhoea 
uses the subjoined solution by way of irrigation : cryst. 
carbol.c acid, 5 grs. to the ounce, and chloride of zinc, 
2 grs. to the runce of water. He has a reservoir hold- 
ing a quart or more, five feet above the patient's penis. 
A rubber tube, size No. 6, terminating in a flexible 
catheter, is attached, and the catheter inserted into the 
urethra, but not into the bladder. A quart of the solu- 
tion is placed in the reservoir and allowed to run into 
the urethra, where, escaping from the eye of the cathe- 
ter, it runs out again between tlie catheter and the 
walls of the canal, giving the latter a thorough and 
long-continued drenching. The effect, he says, is ex- 
cellent. 

Tnh: Fattv Kidney. — James Tyson, M.D., Philadelphia 
(Plii'a. 2fed. Times), in a clinical Iccturo " On a case of 
smooth white kidney," mentions the two forms of 
fatty kidney, viz.: the smooth ivhitt kidney , and the large 
yellow fatty Icidney ; the former being the more com- 
mon sequel of acute Bright's disease, especially of the 
scarlatinal type. Generally fatal within three or four 
years, it is said by Dickinson and Stewart to be amen- 
able to successful treatment. lie has never seen a case 
of recovery, although he has seen the strength and 
general health of a patient temporarily restored while 
the urine still gave evidence of the existence of the 
disease ; and that the duration may exceed the usual 
period is evidenced in the case presented — lasting appa- 
rently thirteen years. 

Cases of the large yellow fathj kidney are invariably 
fatal, and generally within a year after its detection. 
This form of fatty kidney. Dr. Dickinson believes, is 
more frequently a sequel of the acute nephritis follow- 
ing exposure to cold than of the scarlatinal nephritis. 
Dr. Tyson can suggest no reason why it should not suc- 
ceed scarlatinal nephritis; though he has never known 
it to do so. He also believes it may originate primarily, 
especially in the intemperate. A case came under his 
observation which, he thinks, originated in this way — 
in the driver of a beer wagon. The drivers of these 
wagons perhaps consume more spirituous liquors than 
any set of laborers, because they are expected to invite 
the purchaser of every cask delivered to drink with them 
— and whiskey is generally taken. 

Incomp.^tibles with the Perchloride of Iron. M. 
Bouilhon {Xew Remedies' translation from L' Union 
Pharm.) gives the subjoined list of incompatibles : 
Salts of silver; protosalts of mercury; alkalies, their 
carbonates and bicarbonates; the arsenites and arseni- 
ates; borate of soda; tannin and vegetable astringents; 
gums; vegetable extracts, and vegetable infusions; albu- 
men ; casein. 



THE MEDICAL RECORD. 



61 



The Medical Recoiid: 

.1 SEMr-3WXTIILV JOURNAL OF MEDICINE 
AND SURGERY. 

GEORGE F. SHRADY A.M., M.D., Editor. 



Publis/ied on the lat and loth of each Month hi/ 
WMf. WOOD «& CO., 27 Great Jones Street, 3V. Y. 



N^ew York, INIarcli 15, 1872. 



THE PROPOSED 

DEPARTMENT OF SAFETY 

IN THE 

CHARTER OF COMMITTEE OF SEVENTY 

AND THE 

HEALTH DEPARTIVIENT. 

The present Health Department of the City of New 
York is not one in which either the physician or citi- 
zen can take any special piide. The charter which 
brought it into existence was framed more for the sake 
of extending tlie patronage and perpetuating the power 
of the Tammany Ring than for any design of serving 
the legitimate interests of the public. Although, 
a? a department, it may, by comparison with others, be 
considered a very useful one, it has by no means escap- 
ed the contamination which its origin and associations 
forced upon it. ISTo one was surprised to find that it 
was badly constructed, and none are disappointed^ in 
learning that it has been badly managed. It is certain- 
ly some comfort to know that as the community could 
not expect much from it, that it is not now disappoint- 
ed. The medical element of the Board, the most im- 
portant of all, was designed to be of the utmost insigni- 
ficance, and the facts of experience have shown that 
the expectations of the framers of the law have been 
fully realized. Practically speaking, we might say that 
the medical commissioners have been the merest ciphers 
as to any intluence Avhich their opinions or counsels 
may have had upon their colleagues. The profession 
have yet to hear of anything to the contrary of such a 
supposition. No one could expect it to be otherwise, 
as the Board was constituted, there being but two 
medical commissioners, with the Health Oflicer of the 
port, against six laymen. It is conceded by every 
disinterested person, that there are many questions 



connected with sanitary science upon Avhich medical 
men only can give any intelligent opinion. These 
questions are not unfrequently of the greatest impor- 
tance to the commonwealth, and when they are mis- 
understood by layman who have, by the mere force of 
votes, the power to cancel a strictly scientific opinion, 
the consequences are t;ometimes disastrous. Medical 
opinions upon matters connected with the public 
health are not generally calculated to further the in- 
ti'rests of unprincipled contractors, and such others as 
by their vocations are abettors of dangerous nuisances. 
Such being the case, ii is easy for the layini n in the 
majority to be convinced to a contrary opinion, more 
especially if the Board is working for political capital. 
We contend, in the interests of the people, that in order 
that all truly scientific questions connected with public 
health should be properly considered and practically 
answered, that the medical members should have the 
controlling power. They should, in other words, be in 
the majority. The medical profession have a right to 
insist upon such a provision, and the public, if they 
properly understood its importance, would demand it 
of their law-givers. 

It was the lack of a medical majority in the Com- 
mission that has in a great measure rendered it so bar- 
ren of practical results as compared with the Metropoli- 
tan Health Board, of which the city had no little 
reason of being proud. In fact, the only redeeming 
feature of the present Commission, and the only meas- 
ure that perhaps enabled it to cover up the ignorance 
of the framers of the law, was the retention in ofiice of 
such of the executive officers as had distinguished 
themselves under the old regime. It is but due to 
these latter gentlemen to say that they have accom- 
plished by hard work every good and acceptable 
service for which the membei s of the Commission 
claim the credit. While we have reason to congratulate 
ourselves that the affairs of the Board are not on this 
account as bad as they might have been, we have no 
right to expect that such a rule will be so luckily fol- 
lowed out in future. On principle, it is just as liable to 
be violated as not; in fact — in accordance with the ac- 
cepted political principles of the day — more so. The 
only way to prevent the possibility of the appointment 
of incompetent men to do the executive work of the 
Board is to have the medical commissioners in the 
majority. Then we shall always have a guarantee for 
the appointment of men to do the executive work who 
have *he requisite professional capability, and not trust, 
as we have done, to the mere luck of a forced expedi- 
ency. 

The proposed charter is framed upon the principle 
of minority representation, a feature which, under the 
present circumstances of the city government, is com- 
mendable in many ways, and impracticable in others. 
By it the legislative power of the corporation is vested 
in the Board of Aldermen, who are to be elected in 
accordance with the following plan, which governs 



62 



THE MEDICAL RECORD. 



all elections within the naming of the said charter : — 
" Each qualified voter in each Senate District may 
give one written or printed ballot witli the indorsement 
" Aldermen," which shall contain a list of not more 
than nine names. The voter may repeat on such list 
the same name nine times, or may make euch list to 
consist of nine diflcrent names, or may repeat any one 
or more name or names on said list as often as he may 
see fit." The principle, if properly carried out, will 
effectually check the abuses of power and influence 
of which the former political rulers of our city have 
been guilty, but in other respects it is a change in the 
forms of appointment which in many cases may not be 
the most conducive to public welfare. It is in politics 
as in everything else, when changes are made there is 
too much liability to travel from one extreme to the 
other. This spirit of radicalism in tlie cause of non- 
partisanship is, in fact, manifest in many portions of the 
charter, and not the least so in that referring to sani- 
tary regulations. 

The charter now in force provides for a number of 
useless departments which are drawing from the city 
treasury witliout an equivalent return in the shape of 
duties performed. As prominent examples of these 
we have the Bureau of Street Cleaning and the Permit 
Bureau. Tiie chief officer of each of these draws a 
salary of four thou.«and dollars for services which are 
merely nominal, and for which a salary of five hundred 
would be an unnecessary extravagance. This fact has 
tended not a little towards making the changes in the 
proposed law so absolutely reformatory and so uncom- 
promisingly radical. Again, the action of the present 
Health Commission, as manifested in the political trick- 
ery which culminated in raising their salarie?, already 
amply renumcrative, has tended to the same result. 
The Tammany party, with a show of reform charac- 
teristic of all their endeavors to swindle the public, 
caused to be passed by the last legislature what is 
known as the " Two per cent. Tax-bill." This pro- 
vided that not more than two per cent, of the taxes 
should be levied upon the assessed valuation of prop- 
erty, out of which amount the whole city government 
was to be carried on. A Board of Apportionment was 
created by this bill to divide the money among the 
several departments and to fix the salaries for 1871. 
It is true that the appropriation required by the de- 
partment was very much curtailed ; but what was 
gained for the apparent benefit of the public in one 
direction was, in the direct interests of the Health 
Commissioners, lost in another. It was ordered that all 
salaries of five thousand per annum and over should be 
reduced twenty per cent. The Commissioners, how- 
ever, with that disinterestedness of the public welfare 
which has characterized their political actions during 
the past year, succeeded in having their respective 
salaries raised to the modest sum of ten thousand a 
year. As this was done before the Board of Appor- 
tionment commenced their labors, the said salaries 



could safely be left to the necessities of the required 
reduction. The result was that, instead of five thou- 
tiand, which they each received before their respec- 
tive salaries became increased, they actually received, 
after the reduction, eight thousand ! It is easy to see 
that the pretended retrenchment was a real benefit 
to the members of the Commission, while at the 
same time the general funds of the Board were 
proportionately reduced in such a way a<5 to cripple its 
legitimate functions. Since the indignation of the public 
h.TS become so justly arous.'d at the extravagance of the 
different departments, the salaries of the Commissioners 
j have, with a great show of a sacrifice for the public good, 
been reduced, since January first. of the present year, 
to their legitimate standard. 

In view of these fact.'*, it is not to be wondered at 
that the Reform Committee have become prejudiced 
against the pre.«!ent Board, and have sought for many 
changes in its plan of organization. Taking the one 
extreme as a starting-point, they have, perhaps natur- 
ally, but not, in our opinion, wi.sely, aimed at the other 
extreme. There is no doubt in the minds of every 
unprejudiced person that the present Commi.ssioners 
have by their actions, as a purely political Board, for- 
feited the confidence and the respect of the commu- 
nity, and that they one and all deserve dismissal; 
but that, on their' account, the whole plan of adminis- 
tration of the Board, as such, should be so thoroughly 
remodelled, is a question of no small moment to practi- 
cal sanitarians. 

Among the changes proposed by the Committee of 
Seventj' is the creation of " The Department of Public 
Safety." In order to give an idea of the provisions, we 
quote the following : — 

"Art. riL, Sec. 43.— The Department of Public 
Safety shall be under the charge of seven persons, who 
shall be a board to be called " The Board of Public 
Safety ; "' said Board shall consist of the Mayor, and 
of si.x Commissioners, to be called "'Commissioners of 
Public Safety," which Commi.ssioners shall be elected 
by the Board of Aldermen in the manner hereinafter 
provided. 

''/Sec. 44. — Between the 1st and loth days of May, 
in the year 1872, six persons shall be elected by the 
Board of Aldermen as such Commissioners ; at such 
election each alderman shall give not more than six 
open ballots, upon each of which shall be printed or 
written the name of one candidate for the office of such 
Commissioner, and each of which shall be signed by 
the alderman voting, and shall be recorded by the 
Clerk of tlie Board. Each alderman may give the 
whole of his ballots for one and the same candidate, or 
may distribute them between six diflerent candidates, 
or in a less number, in such proportion as he may see 
fit. The six persons having the largest number of 
votes shall be deemed elected. In the event of a 
failure to elect six Commissioners, by reason of less 
than six persons having been voted for, or by reason 



THE MEDICAL RECORD. 



63 



of two or more of the persons voted for having re- 
ceived an equal number of votes, under sucii circum- 
stances that there shall be no full number of six 
persons having received a higher number of votes 
than any others, a new election for six Commissioners 
shall forthwith be held in tlu; same manner." 

Section 45 provides that the Commissioners elect 
shall divide themselves by lot into two classes of three 
each, one of which classes shall hold office for three 
years I'rom the 15th day of May, 1872, and the other 
for six years from same date. 

This department also provides lor a division into live 
bureaux respectively as follow : I. " Bureau of Police," 
the chief officer of which shall be ■' the Superintendent 
of Police; " 11. a Fire Bureau, the chief officer of which 
shall be called" the Chief Engineer of the Fire Bureau;" 
III. a Bureau of Health, the chief officer of which shall 
be called the Sanitary Superintendent ; " IV. a Bureau 
of Buildings, the chief officer of which shall be called 
''the Superintendent of Buildings; " and V. a Bureau 
of Statistics, the chief officer of which shall be called the 
Register of Records." 

This Department of Public Safety it is intended shall 
represent the Police. Health, and Fire departments, and 
in addition the Department of Public Buildings. How 
all the supervisory" duties of these can be compressed 
into the labors of a commission of seven persons is an 
enigma in the first place, and, in our opinion, will prove 
to be an impossibility in the second place. The concep- 
tion of such an idea can be explained only on the ground 
of a determination to court a dangerous and stupid 
extreme. We fail to see how this board can, consist- 
ently with even a common-sense idea of their duties, 
attempt to perform one-half of what even as an advi- 
sory committee the community require of them. The 
real work must be done by tiie different heads of 
bureaux, and the Commission must necessarily be more 
ornamental than useful. It is impossible to conceive 
how the Commission can affect the workings of the re- 
spective bureaux except as the passive instruments of 
the necessities of each, or as active hindrances to the 
efficiency of the respective executive departments. If 
the Commission is really to be good for anything it 
should be competent to exercise an intelligent control- 
ling power over all — which, under the circumstances, 
seems to be simply impossible. 

Each of the bureaux, if they require anything, should 
have a commission practically competent to advise and 
direct the executive officers. This should be particu- 
larly the case with the Health Department. There 
are many questions connected with the health of the 
community which, as before intimated, cannot be de- 
cided upon by any save a committee of strictly medical 
men. We have always held to the opinion that a model 
health law should provide for a distinct health com- 
mission, composed, if not entirely, at least of a majority 
of thorough [jr educated physicians who should be com- 
petent to direct the officers under them. Practical sani- 



tarians need no argument to prove the utility of such 
a measure, and the real interests of the citizens de- 
mand it. 

The appointment of such health commissioners 
shoidd be very carefully made by thoroughly compe- 
tent and responsible parties. Far from the acknowl- 
edgment of any such necessity, the Board of Alder- 
men are left with the whole discretionary power of 
electing any applicant they may .sec fit. There is no 
provision whatever for the election of any medical man 
to that office, and yet this Commission is supposed to 
be able to advise intelligently concerning matters per- 
taining to the health of the community ! Even if 
such a provision were made, the medical gentlemen 
could not possibly claim a fair representation in such a 
board, and would be sure to be in the minority when 
any vote was to be taken upon any measure i-eferring to 
proper sanitary regulations. In any event the influ- 
ence of the profession would be, in matters over which 
it is pre-eminently entitled to opinions, a mere cipher. 

Again, supposing the profession were to bo fairly 
represented, what guarantee is there that the aldermen 
could or would make an acceptable choice. Would it 
not be more probable that, under the circumstances, the 
only candidates who would stand any chance for elec- 
tion would be those who could command the most poli- 
tical influence with the Board as a whole ? This latter 
recommendation is not such as the respectable portion 
of the medical profession as a body can allow them- 
selves to court. 

We are constrained to confess, at the risk of being 
considered out of the fashion, that we are in favor of 
the constitution of a Health Commission by itself; that 
this Commission should consist of a majority of well- 
qualified medical men, and that the members should be 
appointed by some more responsible parties than a 
board of aldermen whose official functions as electors 
are so blindl}'- hemmed in by the principle of minority 
representation. A responsibility of appointing the 
members of such a commission in such away, shared as 
it is among so many, amounts to nothing, even should 
the complication of the machinery allow them to come 
to any choice at all. While we may approve of the 
experiment of minority representation, we have no 
liesitation in objecting to the principle as applicable to 
the appointment of the members of the Committee of 
Safety, As a committee we object to it as wholly in- 
capable of performing the duties to be assigned to it, 
especially those as referring to health matteis. There 
is, in our opinion, very little improvement to be made 
on the old Metropolitan Health Bill, not only as re- 
gards its organization, but as regards the responsible 
appointing power. During its operation it gave very 
general satisfaction, and the repeal of the old law was 
not warranted by any improvements which the present 
law effects or the proposed law contemplates. 



<u 



THE MEDICAL RECORD. 



TIIK MKmCAl, WOItl.l). 

TiiK ifnltcal Worhl, for February, comes to us with- 
out an Editor. We arc simply told that " Dr. Reuben 
A. Vanco, wliose name lately appeared as editor, is no 
loiipiT connected witli the Malical Worlil."' This an- 
nouncement is brief and explicit, and the publishers 
evidently scorn any explanation. It is fair to presume 
that this isanotlier one of tliose serious misunderstand- 
ings between the publishers and the editor, in which 
the former being the owners of the periodical, the latter 
is pretty sure to be worsted. But tliis aciion may admit 
of all sorts of explanations, and except from an unpar- 
donable discourtesy to a professional gentleman, who 
has shown himself qualified to conduct such a journal, 
no one would be particularly interested in the matter. 
The affair, however, wears a serious aspect when the 
publishers assume the editorial control of a journal, and 
i npose their opinions upon the subscribers. They 
p:o:nis? almost everything in the line of medical jour- 
nalism, and state that in return for their labors they 
want a circulation often thousand copies per month (!). 
In order to prove to their subscribers that they are 
capable of doing what they promise, and that they fully 
appreciate how the English language should be used, 
we will quote the following paragraph of their an- 
nouncement referring to the prospective ten thousand 
subscribers: "Out of nearly seventy-five thousand 
physicians in the United States, of all classes, there is 
no medic d journal having anything like the above cir- 
culation." We sliould hope not. 

The profes-ion owe it to their self-respect to frown 
down any such presumption on the part of publishers 
of medical journals, and should cease t:> patronize any 
undertaking actuated by such a spirit. We predict for 
th.: journal a deserved failure. 



Ucports Df Societies. 



TOE rn.VRMACY BII.I. 

Up to the time of our going to press, the fate of the 
Pharmacy bill is still undecided. It is now before the 
Health Committee of the Assembly, and in the hands 
of its chairman Dr. Robert Louguray, and the other 
medical members of that committee, it is to be hoped 
it will receive the merit of a favorable report. Senator 
Weismans has done his part in the matter, and it is not 
fair to suppose that Assemblyman Loughrax and his 
medical confreres will be found wanting when the time 
comes to hear from them. The professions of medicine 
and pharmacy, in this city, are alike interested 
in the passage of the bill, and they naturally look 
to their respective representatives in the legislature to 
have their unquestioned rights guarded against the un- 
principled machinations of the defenders of the present 
obnoxious and oppres-sive law. There can be no argu- 
ments against its passage save such as are so strenuous- 
ly urged by the interested office-holders under the pre- 
sent law. 



MKDK'AI. LIIUIAHY AND JOURNAL 
ASSOC lATlUN OF NEW YORK. 

Slated Reunion. February 9, 1872. 

Dii. W. N. Blake.man, Vice-President, in the Chair. 

TENOTOMY IS MVOPIA. 

Dr. R. II. Deubv read a paper upon Progressive Mi/o- 
pia and i's Operalire Cure, advocating the doctrine 
that the large majority of cases of progressive near- 
sightedness are attended \>y, and to a great extent de- 
pendent upon, insufficiency of the internal recti and 
lience to bo relieved by division of one or both of the 
exlerni. The rules, so carefully elaborated by Von 
Graefe, both for determining the propriety of this ope- 
ration, and for securing by it exactly the degree of 
effect intended, were given in detail. Several cases 
were cited from the practice of Von Graefe and others, 
where the myopia had not only been arrested in its 
progress b}' the operation, but had even considerably 
diminished after it; and the paper concluded with re- 
ports of selected cases from the writer's own records. 

Di?. KxAPP, wliile fully endorsing the rules laid down, 
as having rescued the operation from the domain of 
empiricisiii to that of strictly scientific surgery, was yet 
inclined to think the range of its applicability more 
hmited than Von Graefe and his adherents contended. 
In his own experience the cases of myopia attended by 
a degree of insuQiciency of the internal recti, sufficient 
to warrant the operation, were comparatively rare. 
Indeed, while admitting that insufficiency of these mus- 
cles was more frequent in myopic than in emmetropic and 
hyperopic persons, he nmst yet state, in opposition to 
Dr. Derby's assertion, that only a small percentage of 
the cases of near-sightedness was complicated with such 
insufficiency. Few cases of myopia were progressive 
after the age of twenty-four, or thereabouts ; and in 
these severe ones tenotomy was apt to fail of the de- 
sired effect. This, he thought, was due to the aetiology 
of the afi'ection. Pressure of the recti upon the globe 
had probably less to do with its causation tlian persist- 
ent strain of the accommodaiion ; the steady contrac- 
tion of the ciliary muscle interfering with the venous 
outflow at the anterior part of the eye (through the 
canal of Schlemm), and hence producing passive hyper- 
aemia of the choroid with transudation, and softening 
in the coats of the posterior part of the globe, which 
then yield more readily to the intraocular pressure 
and become extended. 

Dr. Pooley agreed with Dr. Knapp, and would cut 
the external recti only in cases accompanied by evident 
muscular asthenopia. 

Dr. Derby insisted upon the insufficiency of the in- 
terni only in cases of prof/ressire myopia, stating that 
it was found in nine-tenths of these cases. It pro- 
duced its eflects, doubtless, not to any great extent 
directly, by causing an increase of pressure upon the 
globe ; but indirectly, by inducing that very strain of 
the accommodation to which Dr. Knapp had referred. 
This was in virtue of the intimate a-sociaiion between 
the contraction of the ciliary muscle and the effort at 
convergence of the optic axes. If this efi"ort were in- 
creased by weakness of the internal recti, the muscle 
of accommodation must be constantly stimulated to 
excessive action. 

Dr. Pomeroy thought the difficulty of converging 



THE MEDICAL RECORD. 



65 



the optic axes was sometimes an advantage to the 
myope. It would lead him, when his eyes were fatigued, 
to abandon the effort to fust^ the two image.-, and use 
one eye only, relaxing the strain upon tiie acconnnoda- 
tion, and placing tlie object somewhat further off. 

Dr. Kx.vrp called attention to the liict that frequently 
the worst cases of progressive myopia were tho?e in 
which this very thing was constant — where the jiatient 
never used but one eye for near work, and where, there- 
fore, there could be no pressure of the recti upon the 
globe, or strain of accommodation from tlie effort at 
convergence. The relation between the effort to con- 
verge the axes and that to accommod.ite was not a 
fixed and necessary one — so much convergent effort 
necessitating so much accommodative — but was purely 
a matter of education. 

NASAL DOUCniiS. 

Dr. Burrall presented two nozzles, to be attached 
to a Davidson's syringe, for showering the nasal cavity. 
The first was about the size of a No. 8 catheter, some 
four or five inches long, and pierced on one of its quad- 
rants Avith three longitudinal rows of holes. The in- 
tention was that wdien the instrument, introduced into 
the nostril, was laid upon the floor of the nose, the outer 
row should throw its streams into the inferior meatus; 
the middle row, into the middle meatus ; and the upper 
row, directly upwards toward the roof of the cavity. The 
second nozzle was the ordinary bent one for washing 
out the posterior nares, except that the rose at its end 
was made to throw three sets of streams forwards and 
upwards on the plan above given. 

Adjourned. 



NEW YORK ACADEMY OF MEDICINE. 

IStuted Meeiiuffj Fehruary ], 1872. 
Dr. E. R. Peaslee, President, in the Chair. 

REPORT ON YACCINATION. 

Dr. Gouverxeur M. Smith was added to the Commit- 
tee on "Vaccination in place of Dr. H. D. Bulkley, 
deceased. The Committee is composed of the follow- 
ing gentlemen : Drs. Elisha Harris (Chairman), Wm. 
C. Roberts, Alfred C. Post, Stephen Smith, Jonas P. 
Loines, Frank P. Foster, Edward H. Janes, and G-ou- 
verneur M. Smith. 

Dr. Roberts read the report, of which the following 
is an abstract: The daily observations and experi- 
ence of physicians have, for seventy years, uniformly 
proved that in their personal exposure to the sick of 
small-pox, and by the severest testing of the attend- 
ants of the sick in hospit-jl, sick-room, and ambulance, 
thorough vaccination continues to give full protection 
against the contagion, for they are freely exposed 
to its presence, and even to its touch, without harm. 
Thorough vaccination is thorough protection against 
small-pox, and is as effective now as in the time 
of Jenner. It is generally admitted, and clearly proved, 
that thorough vaccination protects against small-pox 
without danger to life or diffusing any infection. 
Scarred and disfigured faces are rarely met with at 
the present day, except in persons who, having neg- 
lected to be vaccinated, have taken small-pox in the 
natural way. In proof of this protective influence 
of vaccination, and the liability to infection without 
it, we may mention that in a severe epidemic in Nor- 
wich, England, of 306 persons in several families, 
there were among 91 vaccinated persons, two cases 
of mild varioloid, and no deaths; and of 215 unvac- j 



cinated persons, 200 took the disease, and 46 of them 
died. 

Revaccination is reconmiended, not only as a meas- 
ui'c of renewed secuiity against sinall-pox, but as a test 
of the completeness of the first vaccination. It is ne- 
cessary to test the completeness of protection and to 
exhaust the receptivity of small- pox, and of vaccina- 
tion itself. He who is insu.sceptible to one or more 
revaccinations Avith fresh viius may generally deem 
himself as secure as vaccination, or even an attack of 
small-pox itself, can make him. 

Small-pox, it is true, occurs occasionally in persons who 
have been once vaccinated ; but its occurrence is very 
rare in those recently vaccinated, or revaccinated once 
or ofcener, or in those in whom the first vaccination was 
thoroughly good, as judged by the Jennerian rules for 
vaccinaiion. In these instances the disease manifests it- 
self oficnest in mitigated form, known as varioloid, and 
the protection afforded by vaccination is found to be 
equal to that which is conferred by a previous attack 
of small-pox. It is believed that a revaccination will 
destroy any susceptibility to small-pox infection which 
may remain from incompleteness or imperfection of the 
primary vaccination. In the army of Bavaria revac- 
cination has been compulsory since 1843, and from that 
date until 1857 — a period of 14 years — not even a single 
case of unmodified small-pox occurred, nor a single 
death from the disease. The vaccine virus now in use 
in New York City is justly regarded by the most ex- 
perienced physicians a? trustworthy and effective, and 
afiords all the necessary protection. Yaccine virus is 
not a carrier of other diseases. To a neglect of reason- 
able precautions, and to carelessness in the performance 
of the first vaccination, are due the unmerited discredit 
into which this greatest boon of a merciful Creator has 
occasionally fallen, and the fatal objection of certain 
classes to its employment. Y'ith due precautions, no 
other disease than that of vaccinia will be communi- 
cated. The distinguished English vaccinators, Dr. 
Marson, in 40,000 vaecinations ; Dr. Leese, in as many 
more; Sir Wm. Jenner, in 13,000 sick children and 
adults in London, and Dr. West, of the Children's Hos- 
pital, in 26,000 children — all concur in saying that 
they have never seen any other diseases communicated 
with the vaccine, and that they disbelieve the popular 
reports that diseases are so communicated, nor is the 
child li'om whom the lymph is taken found to be suf- 
feiing from the disease it is said to have imparted. 
Fresh lymph is always to be preferred when it can be 
obtained; but crusts may be used if such lymph is not 
t J be had, and there is immediate necessity for vaccina- 
tion. W^hen practicable, it is desirable to vaccinate 
from arm to arm, with virus taken on quill-slips di- 
rectly from a healthy individual to the arm of another. 

Yaccinaiion, by preventing small-pox, indirectly di- 
minishes scrofulous diseases ; and the death rate of 
most constitutional diseases, to say nothing of small- 
pox itself, has materially decreased as the practice of 
vaccination has increased ; and not only has mortality 
been diminished, but life has been lengthened and pop- 
ulation augmented. The exact reverse is true of the 
former practice of inoculation of small-pox. 

There is no age at which a person should or should 
not be vaccinated, when a necessity exists for im- 
mediate protection against small-pox; but it is best 
done in early childhood, for then the irritation is less, 
and the child unable to relieve itself by scratching 
the part, which, with the irritation of the clothes, often 
interrupts the progress of the vesicle, causes it to dis- 
charge prematurely, and become inflamed ; whereby a 
vaccination, which might have run its course naturally, 
becomes altered, and an inflamed angry sore is pro- 



66 



THE MEDICAL RECORD. 



duced, leaving a deformed and ill-looking srar and a 
diminislied protection. Matter, too. taken from such 
a sore is worse than valueless. The nge of three 
months is, on the whole, to be preferred. The most 
distingnished English authorities in vaccination, Simon, 
Marson, Soaton, and others, recommend, as preferable, 
and as ensuring greater idtimate protection, four or five 
separate good vesicles ; and of these, in taking virus for 
the purpose of vaccinating others, one at least should 
remain untouched. 

The utmost care should be taken, in the performance 
and managem«'nt ofa (irst vaccination, to make it as near- 
ly perfect, regular, and exhaustive as pos-ible ; for upon 
this depends very much the after-susceptibility to small- 
pox, and it is very doubtful whether any amount of 
subsequent revaccination will fully compensate for the 
deficiency of the first. 

The period for revaccination may be delertnincd by 
circumstances ; it never can be done too early or too 
promptly in persons exposed to small-pox, and it should 
be performed in every person soon after the age of 
puberty, however frequently it may be repeated at 
earlier or later periods of life. It may succeed at one 
time when it would not at another; indeed, it appears 
to be true that revaccination, as well as primary vaccina- 
tion, actually takes more readily in some years than in 
others. "One thorouiihly good vaccination to start 
with," says Seaton, " and one careful revaccination 
after puberty, are all that is ueces-ary for protection as 
complete as any know-n proceeding can give against 
small-pox." After the twenty-fifth year of age the lia- 
biUty to small-pox in the well vaccinated is very small. 
Of the nearly 50,0(10 rcvaccinations in the Prussian 
army in the year 1833. only about one-third were per- 
fectly successful ; resembling, that is, the results of a 
primary vaccination so closely as scarcely to be distin- 
guished from it ; the remaining two-thirds being more 
or less modified, or failing entirely. In other trials on 
a large scale the success has not been as great. It should 
be remembered that secondary small-pox occurs on an 
average in about one per cent, of cases ; and that while 
we urge revaccination both as a test of remaining re- 
ceptivity to it and of further exhaustion of Avhat may 
remain, it is well known that a single well performed 
vaccination, perfect in all respects, with few exceptions, 
suffices to secure for life an individual subjected to it. 
The small-pox has lost none of its malignity and viru- 
lence, and while unvaccinated persons are allowed to 
accumulate, it is vain to hope for any exemption from 
epidemics of greater or less extent. In times of epide- 
mic prevalence of small-pox, all should encourage vac- 
cination. Vaccination and revaccination are positive 
duties. In order to give complete and assured protec- 
tion against small-pox, every person not recently and 
thoroughly vaccinated should be at once revaccinated, 
and in subsequent life should repeat this duty as often 
as every five or six years, until in adult life the repeated 
revaccination cease to have effect. 

Dr. Theodore "Walser then read an extended paper 
on "Quarantine Regulations," which we have already 
presented to our readers. 

The Academy adjourned. 



Stated Meeting, Februarij 15, 1872. 
Dr. E. R Peaslee, President, in the Chair. 

DISCUSSIOX OK QUARANTINE REGULATIONS. 

The Secretary read a letter announcing the death of 
CfiARLES A. Lee, M.D., of Peekskill, N. Y., a Fellow of 
the Academy. 

Drs. W. C, Roberts and Elisha Harris spoke of his 



extensive acquirements and attainments in his profes- 
sion, and how much he was esteemed as a teacher and 
editor of medical works. The intere.'-t he evinced in 
the management and treatment of the insane was par- 
ticularly dwelt upon. 

TUE QUESTION OF QUARANTINE. 

The President appointed Drs. Theo. Walser, Elisha 
Harris, J. C. Peters Austin Flint, and John O. Stone 
as members of the Quarantine Committee, according to 
the subjoined Resolution passed at the previous meet- 
ing:— 

Jiesolved, that a Committee of five members be ap- 
pointed \)y the Academy, to examine and report such 
facts relating to Quarantine as will furnish the Acad- 
emy a correct and useful record in regard to Sanitary 
duties, in controlling exotic diseases. 

Dr. a. N. Rell, of Brooklyn, after some preliminary 
remarks, then spoke as follows : Assent to the appli- 
cation of quarantine necessarily involves the acceptance 
of certain propositions, which are, as yet, far from being 
beyond question. One of these questions, ihe po7-tabil- 
ity of yellow-fever poison, has been incidentally con- 
sidered to some extent recently before the Academy ; 
and it is, perhaps, fortunate that the present subject 
has necessity for its appHcation. Quarantine regula- 
tions, in all their bearings, depend upon our apprecia- 
tion of epideniic diseases, and without accurate knowl- 
edge of the natural history of epidemic diseases — 
including of course those usually denominated con- 
tagious — it is altogether impossible to have an intelli- 
gent comprehension of the utility of quarantine. And 
this view of the subject, even at the outset, is not only 
discouraging but humiliating. 

Who among us can confess to understand the natu- 
ral history of any one of the epidemic diseases, which 
we would be likely to class as quaranlinable ? 

"What do we really know of the qualities and attri- 
butes of epidemic diseases ? For it is only that 
which we know, that we should attempt to control. 
Of all the uncertainties in the history of the medical 
art, knowledge of epidemics takes the lead. That 
which has been learned and confidently asserted in one 
generation, or even in one year, is not infrequently 
contradicted in the next. But let us not desjiair, some- 
thing has been learned; enough, it is hoped, to stimu- 
late action and research in a fruitful field, and, at 
least, to try to apply the little Ave have learned. 

All epidemics possess some attributes in common, 
such as alternating periods of development, decline, and 
disappearance. They are about equally liable to occur 
sporadically, or to prevail within the narrow limits of 
places to which they are most common — without ten- 
dency to spread beyond. And 3'et they all have thf ir 
cycles, exhibit marked dispositions to multiply and dif- 
fuse themselves broadcast, and to become pestilential, 
and then again to return to their usual haunts, as if 
exhausted, or having died out, for the want of food, 
and a subclass seems to possess the qualit}' of being 
antidotal to themselves. These characteristics are 
wonderfully analogous to our more accurate knowledge 
of certain living organisms, both in the animal and 
vegetable Avorld. 

The speaker noted some points in natural history, 
and remarked that we might follow out the self-antido- 
tal effects of the whole category of the ferments, and 
appreciate their analogy to certain contagions. 

But besides all this, each epidemic disease should be 
studied by itself; and all its attributes in relation to 
the circumstances of its existence, in common with, or 
in exception to, all the rest and to all other natural 
phenomena, not confined to one place, region, or coun- 



THE MEDICAL RECORD. 



6T 



try only, but through all its various vicissitudes, 
marking well its distinctive signs and properties, and 
the antecedent meteorological and local conditions. 

Already has this kind of investigation progressed far 
enough for the acceptance of certain peculiarities, which, 
by common consent, exclude most epidemic diseases 
from quarantine restrictions. Of such are, measles, 
whooping-cough, scarlet fever, diphtheria, erysipelas, 
cerebro-spinal meningitis, and relapsing fever; and to 
these may be added typhoid fever, and the common 
forms of intermittent and remittent fevers. The reason 
for this exemption consists in the knowledge of their 
known persistence ordinarily, and permanent existence 
in most communiti(!S which they infest ; or their con- 
tinuance, at least, for months and years at a time, and 
for the most part — particularly the exanthems — their 
marked independence of ordinary local conditions, in 
respect to their general dissemination. These condi- 
tions place such alFections outside of the capabilities of 
quarantine, consistent with reasonable burdens, and 
narrow it down to a final class, now commonly ac- 
cepted as quarantinable, because they, too, have certain 
chai'acteristics in common, and from the knowledge we 
possess of their natural history are, at least, partially 
restrainable by quarantine. 

These are: small-pox, typhus fever, yellow-fever, and 
cholera. The common characteristic of them all is por- 
tability. Of their characteristics individually, scarcely 
could four diseases be selected more unlike each other. 
With respect to small-pox, nothing need here be said of 
its natural history. It will suffice to state, that the ca- 
pabilities of quarantine to restrict it are so slight as 
compared with the universally accepted and only 
means, that quarantine for it should be wholly and ex- 
clusively restricted to the care of the sick, and the dis- 
infection of clothing, baggage, and merchandise, includ- 
ing, of course, the vessel ; and the vaccination of all 
persons recently exposed, or who have not recently had 
the disease. Immediately after vaccination and disin- 
fection of clothing, all such j^ersons should be allowed 
their freedom. 

It should be taken for granted that every communi- 
ty protects itself against small-pox by vaccination; 
that this is an accepted recourse of internal hygiene 
which annuls the exceedingly sUght danger from the 
practice herein advocated. 

Typhus Fever. — In regard to this disease, if I remem- 
ber corrpctly, I must take issue with Dr. Walser. Less 
portable, I have no doubt, than yellow-fever, but at. 
least sufficiently so; in my judgment, to contaminate 
clothing and certain merchandise and, above all, vessels. 

Aitkin says: "There is ample proof that typhus 
fever may be commiunicated by fomites — adhering to 
apartments, articles of clothing, and the like ; and pro- 
vided fresh air be excluded, it is known that such 
articles will retain the poison for a long time. Herein 
lies a fallacy which pervades the argument from cases 
to prove the generation of the disease de novo. The 
poison may be said (like that of small-pox) to be con- 
stantly in existence . . . ; that it is undoubtedly 
propagated from pre-existing foci, and by continuous 
succession. There are also good grounds for believing 
that typhus fever may be communicated, and even 
carried a great way, hy fomites, or by articles of clothing 
strongly impregnated with the specific poison." 

Murchison, also, gives a number of striking examples 
of the communication of typhus from fomites; and 
particularly the recent case of the Egyptian ship " Sche- 
ah Gehald," at Liverpool, the crew of which disseminat- 
ed the poison of typhus by their clothes and person?, 
although, he says, they had not the disease themselves. 
Subsequent investigation of this case by Dr. Parks and 



others showed that some of the men belonging to the 
ship had had the disease, and communicated it by its 
more usual means — personal contagion ; but this fact 
does not impair the other, that it was also disseminated 
by the clothing of the well. Pringle, Lind, Bateman, 
Jacquot, and othci'S give numerous examples of the 
persistence of typhus poison in rooms, attached to fur- 
niture, clothing, etc. ; and Lind, in particular, of typhus- 
infected ships, which continued to impart this disease 
long after the original sick had been removed. Jacquot 
gives similar examples in his account of the Crimean 
typhus on board the French ships. A number of the 
French transport ships took infected troops from the 
Crimea to Constantinople. Among the passengers who 
embarked homeward, typhus frequently broke out, 
without any reason to suspect that it had spontaneous 
origin. 

Lini] mentions cases, where persons, not ill them- 
selves, have by their clothing imparted the fever to 
whole ships' companies; and he also'cites the danger 
to washerwomen and nurses from clothes and bedding. 

Says Murchison, Woollen substances, in particular, 
are the most prone to absorb and retain animal exhala- 
tions, and most fitted to transmit typhus poison, and 
reprehends the use of street cabs for the conveyance of 
typhus patients. 

Surely after such well-proven dangers — and more 
might be cited — the danger of contaminating certain 
articles of commerce, such as woollens, for example, in 
a badly typhus-infected ship, would hardly seem 
questionable. 

Cholera. — By the epidemics of this disease during 
the last ten or twelve years, we have learned enough 
of its history to be quite certain that it is at least con- 
strainable, if not controllable, by quarantine. It would 
be useless, in this presence, to rehearse the history of 
recent epidemics, and its now accepted mode of dissem- 
ination, or to cite the numerous examples of its trans- 
p)ortation, not to say its portability — by both vessels 
and fomites. 

If I am not mistaken, Dr. Walser would confine his 
quarantine regulations ibr this disease wholly to per- 
sons. The vessel in most cases, and the cargo in all, he 
regards as invulnerable. No doubt, this would be good 
practice in many cases, but most of us are sufficiently 
familiar with its fatal portability by means of personal 
clothing and baggage, and its extension from one vessel 
to others, and toshores in the vicinity; without conti- 
guity, in Jaffa, Alexandria, and several other places in 
1865-6. And all of us know the increased danger of 
stale cholera discharges within certain limits ; and some 
of us, at least, know the extreme liability of these dis- 
charges to get adrift on board ship — and to spread and 
pernieate, it may be (for we know not how small or 
how volatile this cholera poison is), not only every part 
of the ship but into the material of merchandise, as well 
as personal clothing. 

All of this, to say the least, is perfectly consistent 
with the nature of cholera poison, to the extent of our 
knowledge, and it is to just that extent that I would 
apply the quarantine and disinfection of merchandise 
and vessels, as well as persons, in efforts to restrain 
cholera. 

Yellow-Fever. — The natural history of this disease 
has recently been so ably presented by Dr. Nott, and 
its acceptance as one of the most quarantinable of dis- 
eases is so generally acknowledged, that little need be 
said of it in this connection. I avail myself, however, 
of this opportunity of strengthening my evidence in 
regard to the portability of the particular epidemic of 
1847-8, which Dr. Nott quoted authority for pronounc- 
ing otherwise. On referring to certain records in my 



r.8 



THE MEDICAL RECORD. 



po.=scs'ion for tlic j-oar 1848, I fiml (hat tlie number of 
ycllow-ffvor inR-(;tod vessels from tlic l.'Uli of Mnrcli of 
that year to iho o:ul of Dt'ccinbcr, a jH-riod of nine and 
a lialf month.-!, was 44, — the largest numbi-r, I believe, 
on record for tliis port for any one year, with the single 
exception of 1850, when there were, from the 1st April 
to tlie 1st t)f Angust, 47. 

Finally, in regard to quarantinable epidemics, as well 
as most others, it may be safely stated, iiro conditions 
are generally necessary to their introduction into most 
communities: The presence of l\ic special poison; and 
the susceptibility of the place as well as persons to 
which the j>oison is applied. That, however rigid quar- 
antine restrictions, if there be not also rigid internal 
cleanliness, quarantine is likely to be inefteclual. 

Dr. Wal>er and others tell us that by the fumes of 
chlorine, sulphurous acid, iodine, bromine, vaporized 
carbolic acid, and such like, applied to the hold of a 
ship, or even to the outside surface of such a mass, it 
is disinfected. Impossible. 

It may be freely conceded, that if the infected mass 
could be penetrated with chlorine, bromine, or iodine 
the living organic matter therein would be destroyed. 
Years of reflection and increased opportunities of test- 
ing its efficacy confirm all that I have hitherto advo- 
cated in regard to the use of steam as the only available 
means with which I am acquainted, for the disinfec- 
tion of vessels under the circumstances described. Chlo- 
rine and other vupor.s that have been, and can be, added 
when deemed necessary, no doubt contribute to the 
potency of steam under extraordinary conditions, but, 
for the most part, they are unnecessary. For, while it 
is perfectly practicable to raise the water at the keel- 
tson and the mud in the limbers to a boiling tempera- 
ture, there has as yet been no instance within my 
knowledge, of the revivication of infection after subjec- 
tion to a temperat;ure of 175° for a period of two 
hours. 

Dr. Bell concluded his remarks by giving a brief 
abstract of the Merchants' new quarantine bill now 
before the legislature. Its chief improvement on the 
laws as they now obtain consists in doing away Avith 
most of tlie abuses pointed out by Dr. Walser, such as 
the interminable detentions, abuses of lighterage, etc., 
but retains the clause m regard to all foreign vessels 
being subject to visitation. This he approved of, not 
for the reason given by Dr. Walser for its first enact- 
ment in 1856, to make the Health office lucrative, but 
because of the greater liability of vessels from foreign 
ports to infection, and the necessity for exacting clean- 
liness. The proposed law provided that such vessels, 
having no disease on board, shall be detained no longer 
than requisite for due examination in this respect. It 
also makes a distinction between the treatment of ves- 
sels and merchandise infected with the different quar- 
antinable diseases ; exempting the merchandise of 
vessels with small-pox and typhus fever from lighter- 
age, and subjecting that of vessels with cholera to 
lighterage only under exceedingly rare conditions. 
Cape Henry had been substituted for Cape Henlopen, 
in the latitude, and May for April, in the scope of 
restrictions. The Board of Appeal has been changed 
by adding to the Commissioners of Quarantine the pre- 
siding officers of the Chamber of Commerce and the 
Ship-owners' Association. 

Upon the whole, the speaker considered the proposed 
law a great improvement, while it was a substantial 
contradiction tj allegations that had been made against 
the merchants of New York, that they are unwilling to 
gubmit to just quarantine restrictions. 

Dr. Elisiia Harris, in making the inquiry, How 
much danger is there from these exotic diseases ? — said 



that having answered that, how is it that we exact so 
mueli from the ."^hip if there is so much danger from the 
disease's? He tlmuglit tiie danger from yellow-fever 
was exaggerated and misstated. Only two per cent, 
of the vessels coming from infected j)orts have been 
really found subject to suspicion. If two per cent, is 
the true amount, this aspect of medical re.-ponsibility 
to the public is not really understood and appreciated. 
None of the quarantine laws are based on sound rea- 
son, much less on medical science. The public should 
be protected from a medical point of view. The 
speaker was pleased with the spirit manifested by 
medical mt^n for advancing tlie public interests, and 
the relief of burdens, and advocated more organization 
of sanitary autl'orities. 

In regard to the reform bill now before the legisla- 
ture, the trouble was that the management rested in 
the hands of members outside of the medical profession, 
with the exception of Dr. Bell. The Board of Appeals 
was so made up, that if the jihysician was necessarily 
absent, not a medical man would be represented. 

The subject of quarantine has assumed a new aspect. 
According to Pettenkofcr, quarantine does not pre- 
vent cholera from going from place to place. It is the 
easiest thing in the world to get up a panic in regard 
to quarantine. If the sanitary au thorites of the cities 
of New York and Brooklyn were consulted, in refer- 
ence to the framing of quarantine laws, and matters 
pertaining to them, it would be well; but the whole 
management is outside of them He contended that 
nine-tenths of all the detentions to ships could be 
prevented if all that Avas known could be applied. 
This placing the whole external measures of hygiene 
outside of medical management has the effect of 
exhibiting the profession in an erroneous light. 

Dr. Walser remarked that typhus fever was scarcely 
known in Continental Europe. He could not see how 
typhus and other eruptive diseases could infect the 
vessel and cargo. During his long experience not a 
single case of cholera was known to originate from 
vessel or cargo. In vessels with tj'phus fever on board, 
disinfection should be confined to clothing. 

He would concur with Dr. Harris, that all quaran- 
tine laws are vrorse than useless unless they are na- 
tional in their character. Quarantine regulations are 
made odious, for the reason that the subject has become 
a political hobby and a source of annoyance to private 
parties. 

Dr. Harris would not depreciate the importance of 
using vigor in the prevention of disease, if faithful men 
are on guard and report truths. Dr. Walser himself 
could state that, when on duty at the Health office, 
strong influences Avere brought to bear to keep the 
truth back, as it was for the best interests of other than 
medical men to give the facts. W^hat is now needed is 
a medical local organization competent to grasp the 
subject. 

In regard to the application of steam as a disinfec- 
tant, Dr. Walser said that he applied steam in one case 
for thirty minutes, and the whole veneering of the 
cabin came oft'. He never tried it again. 

Dr. Bell asked if the disease was not killed notwith- 
standing the loss of the veneering. The destruction of 
paint and veneering is of little consequence in compari- 
son to the detention of vessels. The application of 
steam only takes two or three hours. 

He stated that the majority of merchants were will- 
ing to regard the necessity of quarantine, and were 
desirous of submitting the matter to inteUigent physi- 
cians. 

Dr. JonN C. Peters: — As regards the quarantine 
of small-pox, I disagree witli Dr. Bell when he assumes 



THE MEDICAL KECORD. 



69 



that mercliandise on board the infected vessel should 
be disinfected; it is only necessary to thoroughly 
cleanse und disinfect the persons, bed and body cloth- 
ing, and baggage of the sick persons; vaccinate all 
the rest, and thoroughly cleanse and disinfect those 
parts of the vessel which have been occupied by those 
sick with varioloid or small-pox. The cleansing of 
the hair and liead of the varioloid convalescent is of 
tlie greatest importance: every crust and scab should 
be removed from the scalp, and the head should be 
thoroughly c'eansed and disinfected before the person 
is allowed to mingle with others or to land. The whole 
person, head, hair, and all, should be repeatedly soaped, 
washed, cleansed, and purified. 

I also dissent from Dr. Bell's assumptions that the 
poison of ty[)hus fever adheres to merchandise on ship- 
board with any tenacity; the httle that may cling to 
bales, boxes, or barrels is quickly dispersed by com- 
paratively slight exposure to fresh air. But the persons, 
bed and body clothing, and baggage of typhus-fever 
patients require the most thorough cleansing, soaping, 
and disinfection, and even steaming or fumigation is 
not amiss. 

I also deny that any of the cargo becomes affected 
in cholera ships. The persons, clothing, baggage of 
cholera patients, and those portions of the ship occu- 
pied by them should be most thoroughly cleansed and 
purified, as should the baggage and effects of all those 
coming from cholera ports. Water closets, cuddy 
holes, latrmes, and all personal conveniences, and the 
sides of the vessel, should be thoroughly cleansed and 
disinfected, as well as the steerage and all parts of the 
ship previously occupied by cholera patients. 

I am convinced that all the precautions which are re- 
quired against scarlet and typhus fever, small-pox, and 
cholera should be enforced against the persons, clothing, 
and baggage of yellow-fever patients ; and that yellow- 
fever ships should be more thoroughly cleansed, disin- 
fected, and fumigated than any others; but even in 
these ca^es the cargo, even if it consist of coffee, sugar, 
molasses, etc., etc., is rarely or never infected. The 
best way of disposing of a yellow-fever or cholera ship 
is to unload its cargo as rapidly as possible, with the 
full assurance that no disease will be conveyed by any 
portion of the cargo to the neighboring shore. The 
ship could then be very rapidly purified, and made 
ready for another cargo, or could be sent off' in ballast to 
the place from whence it came. 

New York harbor, by the establishment of the lower 
quarantine, now escapes from the greatest of all dan- 
gers, that to which it had always been subjected pre- 
viously, viz.. the contamination of its waters by the 
presence of cholera, typhus fever, small-pox, or yel- 
low-fever from ships. It is not only possible but prob- 
able, as suggested by Dr. Bell, that cholera, typhus and 
yellow-fever ships bring in their holds, or rather in 
the spaces between their inner and outer plankings, an 
enormous quantity of cholera, or yellow or typhus fever 
filth which has soaked into them from the filthy docks 
in which they lay while loading. Again, it is equally 
true that a great deal of such filth drains down from 
the decks and steerage into these inter-rib spaces, if 
the disease breaks out with any intensity on shipboard. 
This is pumped over the decks with the bilge water, 
and contaminates the surrounding harbors and anchor- 
ing places. Again, all the discharges of cholera, typhus 
and yellow fever patients, and all their refuse, used to 
pass, without disinfection, into the waters of the harbor, 
especially into the bays and shallow places where ves- 
sels at quarantine usually anchor. It is very well 
known that persons bathing in these waters would 
contract disease very readily ; and several instances 



have become historical, in which gales of wind threw 
these contaminated waters upon the Staten, Long, and 
Governor's Island shores, and occasioned wide-spread 
epidemics of yellow-fever and other diseases. 

From the most of these dangers we are now happily 
released by the removal of quarantine down below the 
Narrows. It only lemains to release commerce from 
the unnecessary delays, burdens, and fleecings which 
have so long been mercilessly heaped upon it in the 
name of Hygiene and Medical Science. 

Da. W. C. Roberts, Vice-President, remarked that 
the question of the contagiousness or non-contagious- 
ness of yellow-fever was one of the most interesting 
and practically important features in its history ; and 
he sliould very much have liked to [lay before the 
Academy some observations he had prepared, from 
reading and refiection, on the subject. 'I'hese he hoped 
to have a future opportunity of submitting to his pro- 
fessional brethren. 

Insusceptible, perhaps, of positive p oof, it was only 
from a certain line of argument in relation to contagion, 
as applied to this as well as to cveiy other contagious 
disease in the catalogue, that that of yellow-fever could 
be inferred. 

The study of the history of the disease, the speaker 
said, presented the curious anomaly of a large number 
of physicians, who, having for a long time been firmly 
convinced, from personal observation, of its conta- 
giousness, had renounced that opinion and embraced the 
opposite; of many, and most, it must be acknowledged, 
who, denying its contagiousness and believing in its 
local origin, looked with doubt upon quarantine regu- 
lations lor its exclusion ; of men who believe in the 
specific cause and nature of yellow-fever ; and of others, 
again, Avho see in it little or no difference from bihous 
levers of a high grade, and doubt of its specific nature. 
Others, again, believe, that although originally non- 
specific and non-contagious, it may, under certain cir- 
cumstances, become such ; and that, even on a voyage, 
the air in a dirty hold, especially with sickness on 
board, might contract contagious properties. All these 
views are maintained by able men, and by seemingly 
convincing arguments. The contagionists affirm the 
origin of the disease from infected vessels ; adduce 
proofs of its communication from the sick to the well, 
even in pure atmospheres; and adduce such examples, 
by way of illustration, as would be deemed conclusive 
in regard to any contagious disease acknowledged to be 
such. The non-contagionists deny its importation, or 
not, and confine themselves to showing that in nu- 
merous instance-! it was not disseminated, nor caught 
under favoring circumstances, etc. ; the positive asser- 
tions of the one class, once the most numerous, being 
counterpoised by the negative statements of the other. 

Dr. La Roche, in his elaborate work on Yellow^ever, 
which contains about all that has been written on the 
subject, devotes to "proofs of contagion" fifteen pages, 
on reading which, one would suppose the question 
definitely settled; and three hundred and fifty pages 
to the opposite view — showing, not what yellow-fever 
did do on occasions of its occurrence, but what it did 
not do. Many of his " proofs " of non-contagion are 
inconclusive ; some not apposite, and some not true : 
probabilities only op) :o-ed, to what others might affirm 
to be clearly estabhshed facts. Upon the subject of 
actual contagion he scarcely touches. 

Believing the disease to be one oiiginating from 
specific causes, of specific nature, distinct from others 
even similar in character, and having, as he believes, 
the power to show instances of personal contagion 
strong enough to insure conviction in this or any 
other disease of specifically contagious nature; and 



ro 



THE MEDICAL RECORD. 



taking into view the interesting and practically im- 
portant duiractor of the investij,'ation, tUc Doctor 
hoped to 1)1' iililc, at some fiiluro ])tMiod, to lay the re- 
sults of his inquiiios liofore the medical profession for 
a verdict on iluir merits. 

Which is the safer for individuals and communities, 
to admit and iict upon (he ide^ of its contagiousness, 
or to disregard it and risk the eon>equences? 

The President announced tliat L)r, E. G. Loring 
wouhl read, at the next meeting of the Academy, 
March 7. a paper on " Modern Methods of Extrac- 
tion." 

The Academy then adjourned. 



Corrcspouticucc. 



A FATUOUS PROFESSION AND INFA- 
MOUS MEDICAL COLLEGES. 

To THE El>ITOR OF THE MEDICAL RECORD. 

Sir — Some hiy;hly respected and unquestionably honest 
members of our profession read a report relative to 
medical education at the last meeting of the Medical 
Society of the State of New York. (See the Record for 
Feb. 15, 1872, page 559.) While I entirely sympathize 
with them in the objects of that report, I am convinced 
that the measures thej"- propose are totally hopeless of 
desired results. 

Whoever pleases can sec that the report above al- 
luded to adopts, and reproduces the impracticable 
scheme suggested by the Committee on Educotion of 
the American Medical Association, and printed nearly 
three years ago. I had occasion, in my paper read be- 
fore the State Society at the same meeting, to quote 
from that report of the American Medical Association, 
simply to show that the whole history of the subject 
went to demonstrate that the plan proposed by that 
report is impracticable. It is therefore to be regretted 
that our State Society Committee slinuld have been 
reduced to the necessity of even alluding to any such 
scheme for the moral and educational elevation of the 
profession. 

If your readers will take the trouble to read the in- 
felicitous and untruthful resolutions proposed by the 
Stale Sooiety Committee (page 5G0), I have little doubt 
they will appreciate the point of tlie above remarks. 

Alter reading those resolutions, will any one please 
to tell us how any board of censors therein provided 
or contemplated can secure the attendance before them 
of any proposed medical student ? 

Wiiat means have Ave for enforcing the fourth reso- 
lution, (see page 5G0) ? It is morally certain that 
even among members of the county .societies this 
resolution will be extensively disregarded;" and as to 
the large number and often respectable members 
of the profession not members of county societies, it 
will of course be nugatory. What, for example, can 
the censors do, under the provisions of this resolution, 
with reference to the students of one of our most dis- 
tinguished teachers who, by accident or otherwise, does 
not belong, by virtue of membership, to any county 
medical society ? 

But the most striking failure of the report and its 
resolutions is found in the complete want of any pro- 
vision for the eases of medical colleges which become 
so venal as for a few paltry dollars to scandalize the 
honest and industrious students they may have, and 
degrade and outrage professional feeling by issuing 
diplomas to, or even matriculating, creatures who, in 



open court, not only perjure themselves in the vilest 
manner, but who declare, under oath, that lor years 
they hav»; lived upon a practice obtained thiough 
newspaper adverli.sements and by means of cards and 
circulars of the most debased and criminal character, 
distributed in the street cars. 

This is by no means an imaginary ca.«e, as the fol- 
lowing newspaper advertisement, of a recent graduate 
of a once respectable and still prominent medical col- 
lege of the city of New York, will attest: 

■' Dr. . Infallible Pills lor Female Obstructions. 

Twenty years' practical experience have encouraged 
me to introduce an article long needed. These pills 
will surely produce the desired effect, and need no 
further reconmiendation. 

" For sale b}' druggists generally. 

" For particular information apply to the doctor's 

office. No. avenue, between and streets. 

Private office. No. street. From 7 to 9 p.m." 

Of course, the most careful and honorable schools 
are liable to imposition; but of this liability I have no 
other occasion to speak in this connection than to as- 
sure your readers that there was no such deception 
practised in the instance above alluded to. The faculty 
were fully informed in all the details of the case. They 
had the phonographer's report of the declaration under 
oath ; they had the original newspaper advertisements, 
and they had an abundant individual evidence in sup- 
port of charges of most immoral and criminal charac- 
ter. Notwithstanding all this, a few dollars have, 
within the last few weeks, placed the name of such a 
wretch in tlie list of the graduates of one of our New 
York medical colleges. No one will, of course, envy 
that college its acquisition. 

I have named neither college nor individual ; but I 
am ready to do so at any moment the public and pro- 
fessional good appears, in my judgment, to demand it. 

Besides such outrageous acts, it is credibly stated 
that this same college advocates the propriety, and fol- 
lows the practice, of selling their diplomas to persons 
living in distant parts of the State, on the simple state- 
ment of the person seeking it, without any j^resenta- 
tion of certificate or credentials. 

The college, and the case above alluded to, are noto- 
lious; and as a consequence of these disreputable acts, 
its better class of students are highly indignant, and 
will abandon the institution. 

While honesty and morality are the best policy, they 
are by no means always observed, even where it is so 
clearly politic, as in the case of medical colleges. 

Now, acts like that above alluded to are so frequent- 
ly committed by colleges — more eager to secure a few 
dollars than to shun infamy— and so Avell known by 
the gentlemen signing the report, that it is a matter of 
surprise they should have seriously entertained an idea 
that the scheme provided in their resolutions reached, 
or could remedy materially, any evil. None but the 
fatuous can fail to see, that while totally venal and cor- 
rupt medical colleges have control of licenses to prac- 
tise, medical society resolutions of this kind will not 
only be in vain, but be simple expressions of imbe- 
cility. Indeed, this is so well known, that one who 
moves a medical society resolution, in any other than 
a strictly society matter, exposes himself to ridicule. 
Outside of the society they have no significance, no 
influence. This will certainly be the result of any at- 
tempt to carry out the resolution referred to. (Page 
560.) 

But professional fatuity did not stop, at the late 
meeting of the State Society, with these resolutions. 
On page 558 Record, the society resolved again — to do 
what? to disapprove the only even hopeful measure 



THE MEDICAL RECORD. 



71 



proposed in modern times to elevate and control medical 
education, viz., by invoking the strong arm of the law. 
Not to say anyihing about general professional opinion 
regarding this society resolution, it may be well for us 
to know, that the lay opinion of it is by no means com- 
plimentary to the profession. By it the State Society 
has, so far as any of its resolutions could, placed the 
profession before the pubhc on the same footing as the 
quacks and tlie criminal practitioners of the country ; 
Avhile, to our shame be it said, the ignored so-called 
new schools of "pathies," have taken quite the opposite 
course — have accepted the proposed measure as one 
which, though it confers upon them no privileges they 
do not now legally possess, gives material additional 
power to be used for the public interest. 
I need say no more to explain my text. 

Stephen Rogers. 



CEREBROSPINAL MENINGITIS. 

To THE Editor of the Medical Recoiid. 

Sir — The rumor that epidemic cerebro-spinal menin- 
gitis has appeared in some portions of this State, and 
the announcement that some cases have been reported 
to the Board of Health, induces me to write a few lines, 
•with the hope of calling the attention of medical prac- 
titioners, who may have the opportunity of seeing this 
disease, to some details of treatment, and especially to 
the use of the ordeal bean of calabar, which I believe 
has been of service to me in the management of a re- 
cent limited epidemic. 

Since the beginning of November last I have treated 
forty cases of cerebro-spinal meningitis. Twenty-nine 
were well-marked typical cases. The ages of my 
patients ranged from 3 to IG years. Four died: and one 
is not yet out of danger. As this epidemic occurred 
under peculiar circumstances, and presented many fea- 
tures which may be of interest to the profession, I pro- 
pose to publish soon a full report. 

The therapeutics of this disease are notoriously un- 
satisfactory. The mortality of reported epidemics ran- 
ges from 30 to 75 per cent. The death-rate of my cases 
is only 10 per cent. But their number is too small to 
allow any legitimate conclusion to be drawn from such 
hmited statistics as to the value of any particular treat- 
ment. I anticipate my report, therefore, by this pre- 
liminary statement, that others may not miss an oppor- 
tmiity of testing the value of the remedies I have em- 
ployed. 

Waiving for the present all discussion concerning the 
nosology, etiology, pathology, and morbid anatomy of 
cerebro-spinal meningitis, I may be permitted to state 
that the most salient and central feature of this disease 
.seemed to me to be an enormously increased reflex 
irritability of the nervous system, with an attendant 
paralysis of some branches of the sympatheticus. In 
studj'ing my first case it occurred to me that calabar 
bean, which ophthalmologists use in eye-diseases de- 
pendent upon an irregular or interrupted innervation 
of the dioptric apparatus, and which lately has acquired 
considerable reputation in the treatment of various 
forms of tetanus, might be of nse in this disease, the 
symptomatology of which is so largely made up by 
paretic and tetanoid phenomena. 

At first I used the tincture of calabar bean, but after- 
wards I succeeded in procuring the extract. The ex- 
tract was manufactured by Hazard and Caswell, 2^ 
drachms of which are equal to 2 ounces of the bean. 
I had one drachm rubbed up in glycerine and gave 2-5 
drops at a dose. 



I administered this drug in every case, as soon aa 
tetanic contractions or apparent paralysis of the sphinc- 
ter iridis appeared; except in two livtal cases, one of 
which terminated very lapidly, the other occurred be- 
fore I had obtained the extract and after the tincture 
was exhausted. 

In the great majority of cases the drug seemed to 
exert a favorable influence upon the symptoms which 
it was intended to control. In a few of tiie milder 
cases, where there was rather a contracted pupil, 1 ad- 
ministered atropia in pretty lull doses, without, how- 
ever, influencing the general course of the disease. 

In the onset of the attack the symptoms are generally 
so violent, cephalalgia and rachialgia so severe and dis- 
tressing, the skin and mucous membranes so congested, 
that depletion seems the one thing indicated, and yet I 
have resisted every temptation to abstract blood. I 
have neither bled, nor leeched, nor cupped, nor blis- 
tered. Ice in bladders to head and neck mitigated the 
pain and proved grateful to the patient. 

Cathartics I used very moderately, not intending to 
produce any revulsive effect upon the bowels. 

I had no reason to be dissatisfied with this treatment, 
when afterward, in some of the protracled cases, a 
prostration set in as extreme as the precedent violence, 
and a degree of emaciation foJlowed which rivalled the 
marasmus of the everlasting gastro-intestinal catarrh of 
starveling foundlings. 

In the first days, or whenever, in the course of the 
disease, there was great restlessness, or violent jactation, 
I administered moderate doses of chloral hydrate, 10-15 
grains, repeated as required. Morphine I gave only in 
one case where ice seemed unpleasant and headache 
was worse. 

Although there is a certain rhythm and periodicity in 
the progress of this disease, I have seen no reason for 
giving quinine until after convalescence was established, 
and then, in combination with iron, it doubtless proves 
beneficial in re-establishing the vigor of the system. 

In most of the cases periods of coma follow or alter- 
nate with spasms and jactations. In such cases I have 
Ibund the iodide of potassium of service. But this drug 
must be administered with a bold and liberal hand. I 
have given from 2 scruples to a drachm in 24 hours ; 
generally alternating it with the extract of calabar bean, 
so that my patients received every two hours either a 
dose of calabar (2-5 drops) or a dose of pot. iod, gr. 6-10. 

Cerebro-spinal meningitis is not a sell-limited disease ; 
it is protean in its manifestations ; probably more 
frightful in its phenomena than severe in its anatomical 
lesions, — at least in a majority of cases, — and oflers, 
therefore, a hopeful field to the therapeutists, although 
few victories have as yet been won. To induce phy- 
sicians to make new trials I have ventured to state 
briefly the method of treatment I have pursued ; so far 
as its results go, I believe they are more favorable than 
any that have been obtained. 

In general hygiene little could be done in the persent 
state of our knowledge as to the cause of the disease. 
I have used carbolic acid as a disinfectant, and internally 
to some extent. 

In concluding these lines I wish to express my 
gratitude to Piofessor Jacobi, who had the extreme 
kindness to visit my patients with me, and to whose 
profound knowledge of the diseases of childhood and 
skilful application of modern therapeutics I am indebted 
lor much valuable advice. 

Very truly yours, 

C. F. R0DENSTEI>f, M.D. 

Westchestek, March, 18T2. 



IIIK MKIHCAI. IlKCORI). 



i^ctiicnl 3tcm!5 anti llcws. 



CoLLKGK OK I'livsrciANS AND SuRORONs. — Thc sixty- 
fifth Aiimial Coninit.'ncoiiicnt took place at Steinway 
Hall. February 28. Alter a prayer by thc Rev. Dr. 
llutton, IVe.^icient Delafiuld conferred diplomas upon 
seveniy-eiglit <,'raduates. 

Prot^ Dalton annoimced the iolluwinjr award of 
prizes: — 

Faculty prizes for the best two Inaugural Theses : 
first prize, of fift}' dollars, to William Tiilin}.diast Bull. 
A.B., of Newport, R. I., lor a thesis upon '' Perityphli- 
tis ;'■ second prize, of twenty-live dollar.^, to Peter A. 
E. Boctzkes, of this city, for a thesis upon "Morbus 
Coxarius." The theses of the following frrntlemcn also 
received honorable mention : Edward K. Ilenschell, 
Xew York City. "Albuminuria;" Geoifre C. Gage, 
Mobile, Ala., "Yellow Fever;" John 11. Seabury, 
Jamaica, L. I., '• Acute Rheumatism ;" T. Naylor Brad- 
field, Newark, N. J., "Diagnosis in Gyn;eeoIo,2y ;' and 
Cornelius Gilman Trow, Sunderland, Mass., "The Ob- 
stetric Use of Carbonic Acid." 

Otis prize, of a case of surgical instrument?, valued at 
fifty dollars, for the best report of the clinical and di- 
dactic lectures on venereal diseases, to F. W. Cliapin, 
of New York City. 

Alumni Association prize, of four hundred d( lla's, for 
the best essa}^ presented by an alumnus, to Dr. Frank 
P. Foster, of this city, for an essay on " Experimental 
Study of Animal Vaccination." 

The subjects selected for the Stevens Triennial Prize, 
of two hundred dollars, to be awarded at the Com- 
mencement next year, are : 1st. "The Siihygmopraph, 
its Physiological and Pathological Indications;" 2d. 
" The Pathology, Symptoms, and Treatment of Con- 
vulsive AfTections." This prize is open to universal 
competition. The Essays must be senttc^>tlie President 
of the College on or before January 1, 1873. 

The valedictory address was given by Samuel Swift, 
Ph.B., M.D., of the graduating class ; and the address 
to the graduates by Rev. Henry Ward Beecher. Some 
extracts from our notes of the latter, which we had 
proposed to give, are crowded out of this number. 

Bef-levue Hospital Medical College. — This college 
held its tenth Annual Commencement February 29th, at 
tlie Academy of Music. The Chaplain of the college, 
Rev. Dr. Beach, ofiered prayer, and administered the 
Ilippocratic oath to a class of one hundred and twenty- 
nine graduates, who received their diplomas at the 
hands of the President, Dr. Isaac E. Taylor. 

Prof A. B. Crosby, M.D., addressed the graduates. 
He counselled them to consider their studies but just 
begun, and to pursus them not only with reference to 
the particular profession they had now entered, but 
quite as much with a view to that broader culture 
without which even their special department, however 
earnest their devotion to it, must be imperfectly com- 
prehended in some of its most important relations. This 
culture must extend to the heart as w^ell as to the head; 
nor must they neglect those social amenities and graces 
of manner whose absence might cheat the kindest 
feelings and the highest skill out of the best opportu- 
nities for their exercise. If tiiat personal magnetism 
by which some men bring us irresistibly under their 
influence was not a thing to be acquired, still every 
one might learn to make his presence agreeable ; and 
the phyrieian would often leave behind him a more po- 
tent remedy than his prescription, in the memory of a 
bright greeting or a happy joke. 

In the illness of the valedictorian, Benjamin L. Lo- 



throp, A.B., M.D., liis address was read by Dr. Wil- 
liam Car:'. Excellent nm.'^ic was furnisheil by an or- 
chestra under Carl liergmann's direction. 

Medical Dki'Ahtment of the T'.niversitv ok New 
York. — The annual commencement of thi.s Medical 
College was held on Tuesday evening, Feljruary 20, 
1872, at Ciiristian Association Hall, which was filled 
with a .«elect audience. The exercises were opened 
with reading of the Scriptures by Rev. Prof Benjamin 
N. Martin, D.D. Rev. Isaac Ferris, D.D., LL.D., 
Emeritus Chancellor of the University, olTered prayer. 
Prof. John W. Draper, M.D., LL.D., conferred the 
degree of M.D. on seventy-five graduates. Certificates 
of Honor were given to eighteen graduates who had 
attended the spring, autumn, and winter courses of in- 
struction. The Mott gold meilal was awarded to Dr. J. 
V. Granger for the best anatomico-surgical jjrepara- 
tion ; the Mott silver medal to Dr. H. C. Munroe for 
the .second best anatomico-surgical preparation; Prof. 
William H. Thomson's prize to Dr. L. P. Ensign for 
the best record of his clinics; I'rof Charles A. Budd's 
prize lo Dr. G. H. Hammond for having passed the best 
examination in obstetrics; Prof. D. B. St. John Roosa's 
prize to Dr. J. A. Ste])hens for having passed thc best 
examination on the eye and ear ; Prof. F. D. Weisse's 
prize to Dr. H. S. Yanderhoof for the best recoi^ds of 
his clinic on skin diseases. 

The valedictory address to the graduates was given 
by Prof. William Darling, which was interspersed with 
amusing and interesting hints. Dr. R. J. Brevard, 
of the graduating clas.s, delivered the closing address. 

The New Health Officer. — The following letter 
has been ad(h-essed to Dr. S. 0. Yanderpoel, the newly 
appointed Health Officer : — 

New Yobk, Febniai-j- 28, 1872. 

S. Oakley Yanderpoel, M.D., Albany. 

Dear Sir : — We have heard with the greatest satis- 
faction of your nomination by the Governor as Health 
Officer of the Port of New York. We regard it as 
most fortunate, for the credit and interests of all con- 
cerned, that the above office should be filled by an in- 
cumbent like yourself, fitted, by every personal and 
professional qualification, to perform its duties in the 
best possible manner. Possessing, as you do, the entire 
confidence and esteem of the profession, your confirma- 
tion and acceptance would be received with universal 
satisfaclion. (Signed) Edward Delafield, M.D. ; John 
T. Metcalfe, M.D. ; Isaac E. Taylor. M.D. ; T. Gaillard 
Thomas, M.D. ; A. Clark, M.D.: \V. H. Yan Buren, 
M.D. : Willard Parker, M.D. ; Alfred L. Loomis, M.D. ; 
William Detmold, M.D. ; T. M. Markoe, M.D. ; A. Du- 
bois, M.D. ; Austin Flint, M.D. ; Chailes A. Budd, 
M.D. : J. C. Dalton, M.D. ; John J. Crane, M.D. ; H. 
B. Sands. M.D. ; C. Henschel, M.D. ; John G. Curtis, 
M.D. ; Edward Fowler, il.D. ; George A. Peter.=, 
M.D.; E. R. Peaslco, M.D. ; W. H. Draper, M.D. ; L. 
Ranney, M.D. ; John O. Stone, M.D. . Gustavns A. 
Sabine, M.D.; C. F. Hey wood, M.li. ; Henry D. 
Noyes, M.D. 

Lostorfer's Syphilitic Discovery. — Professor Wedl 
contests the discovery of pecuhar bodies in syphilitic 
blood, and asserts that they are only mas.ses of fatty 
particles and protoplasm, which are found in healthy 
blood. 

Deaths from S.mall Pox in the seventeen ehiefest 
towns in Great Britain, during the year past, amounted 
to the number of 13,174. 

The Census of Rome. — The census of Rome, just 
completed, shows ^ population of 240,000. 



THE MEDICAL RECOKD. 



73 



©rigiital Communicationsi. 



SOME DETAILS IN THE PATHOGENY OF 
PY.EMIA AND SEPTICEMIA : 

REMARKS BEFORE THE MEDICAL LIBRARY AND JOURNAL 
ASSOCIATION OF NEW YORK, 

By MARYC. PUTNAM, M.D., 

LECTURER ON MATERIA MEDICA IN THE WOMAN'S MEDICAL COLLEGE 
OF THE NEW YORK INFIRMARY. 

As I understand the object of this Association, it per- 
mits its younger members to submit the questions tliat 
may have especially interested them, to the judg- 
ment of otliers older and more exiDerienced than them- 
selves. This is why I venture to make some remarks 
on a subject, vv^hich a rather prolonged sojourn in the 
hospitals of a great metropolis has Ibrced most promi- 
nentl}- upon my own attention, 

Tlie study of putrid and purulent infection, though 
it originate in the province of the operative surgeon, 
immediately rises into the sphere of general pathology, 
and touches upon problems of the keenest interest to 
the physician. Moreover, by a singular fatality, the 
metliods adopted to remedy the effects of accidents, 
expose to many of the same dangers as the accidents 
themselves ; and operations for many diseases of inter- 
nal origin accumulate upon the unfortunate patient the 
additional perils of an external traumatism. Finally, 
while men are more especially exposed to the superflu- 
ous traumatisms of war, women are compelled to incur 
the inevitable traumatism of childbirth; and the ulti- 
mate danger is in many cases the same. 

To judge by certain assertions, one might suppose 
that this danger had been so much diminislied by ap- 
propriate treatment, that it now presented no more 
practical interest than that of the plague. The ad- 
mirers of Professor Lister have far surpassed his own 
confidence' in the virtues of carbolic acid. In the 
Dublin Quarterly for 1869, Mr. McDonnell affirms that 
treatment by Lister's method has attained 'perftction ; 
and that when a wound has been dressed with carbolic 
acid, and its arteries secured by torsion, it is almost 
certain to heal easily, while tlie temperature of the 
body does not rise above 100°. Lister himself, 
in his famous paper published in the British Medical 
Journal for 1867, is not so sanguine. Pie gives no 
statistics, but observes that since the employment 
of carbolic acid for the dressing of wounds, his 
wards, formerly the most unhealthy in the Glasgow 
iofirmaiy, have become comparatively healthy, and 
that he no longer dreads, as before, the advent of com- 
pound fractures. In St. George\'i Hospital Reports for 
1868, Mr. Holmes gives the result of experiments 
made with carbolic acid in forty cases. Lacerated 
wounds and abscesses did remarkably well under this 
treatment; all recovered. Of eight cases of compound 
fracture, four recovered and four died — tv/o of pyaemia, 
one of tetanus, one, on fourth day, without metastatic 
abscesses, tlie case being complicated with renal disease. 
Mr. Holmes had twelve cases of incised wounds and 
operations, including two amputations of the breast, but 
only two involving section of the bones. One of these 
was a Chopart's amputation of the foot; patient re- 
covered after an attack of erysipelas ; the other, an 
amputation of a metacarpal bone, followed by death 
from pyaemia. In this case the patient had diseased 
kidneys. 



In the last October number of the Archiues de Mede- 
cine, Dr. Labb6e reviews the English statistics, and 
points out that, even in Lister's wards, the results of 
carbolic acid treattnent are much less brilliant than 
was at first supposed. Thus, i)revious to tliis treat- 
ment the deaths after amputations were 41 to 120, or 
1 in 3; after its adoption, they were oO in SO cases, 
or 1 in 2.6. During the last six months Dr. Labb^e 
had extensively employed carbolic acid, with ilie most 
scrupulous attention to the details insisted upon by 
Lister, and nevertheless nearly all his ; mputated pa- 
tients had died. This lugubrious statement corresponds 
entirely with the I'acts that I have had an opportunity 
of observing closely. For at least three years the use 
of carbolic or jihenic aciil has been almost universal in 
the great surgical wards of the Paris hospitals ; but the 
mortality has not been notably niodi0ed, and remains 
higher than that of London. 

These remarks, with no pretension to statistical 
value, are merely intended to show that the antiseptic 
treatment is by no means infallible. The phenic acid 
of the moderns is not a panacea, any more than the 
famous sage of the ancients. It follows that the doc- 
trine upon Avhich its employment is based, is not 
sufficiently comprehensive to include all the cases to 
which it is applied. This doctrine is sometimes an- 
nounced in a proposition that rather unfairly combines 
the opinions of Poser on miasms, and of Pasteur on 
animal germs. It is sometimes said that these germs 
constitute hospital miasms, and act either directly, be- 
ing themselves absorbed into the blood, or indirectly, 
after having determined the putrefaction of traumatic 
fluids. The absorption of fluids thus putrefied is suffi- 
cient to account for the most various surgical accidents — 
phlebitis, erysipelas, pytemia, septica3mia, hospital gan- 
grene. In virtue of the assumed unity of their ictiology 
and of their nature, these several alTections are asserted 
to be equally amenable to a single mode of treatment. 
This consists iil'the destruction of animal germs, first in 
the atmosphere, b}'' purification of the air ; second, upon 
the wound itself, by dressings with carbolic acid. 

But, in the first place, the animal germs to which 
Pasteur attributes the mechanism of putrefaction do 
not exist merely in impure air, but even in tolerably 
pure air, unless it be absolutely free from animal or ve- 
getable dust — such air, indeed, as may be brought from 
the summit of Mt. Blanc. To prevent putrescible sub- 
stances from putrefying, it has been shown necessary to 
seal them hermetically, so as absolutely to exclude air. 
Donne experimented on an egg, which he caiefully 
enveloped in cotton wool, and then obliquely jjierced 
by a knitting-needle, previously heated to destroy any 
germs that might be clinging to it. By means of this 
puncture air was admitted to the interior of the egg, 
but only after having been filtered by the passage 
through cotton. The egg putrefied, as it will not do if it 
be covered with an impermeable varnish. But Pasteur 
asserted that the precautions taken had not been suff.- 
ciently severe ; that it was possible to admit some of 
these ubiquitous infusoria during the manipulation of 
the experiment. How much more, then, in any Avound 
not treated by absolute occlusion ! 

In the second place, the researches of Bechamp ai.d 
Estor, communicated to the Academic des Sciences in 
1808, indicate that, though the access ofair be esseniial to 
putrefaction, yet the presence of bacteria in animal pu- 
trefying substances does not depend on their introduction 
from without, but on the development of germs already 
contained in the elements of the tissues themselves. 
Especially in the cells of the liver, both in man and in 
other animals, these observers have discovered certain 
spherical granules which they call microzymes. These 



THE MEDICAL llECDliD. 



rcMiain i^phcricnl as lonp as the organ is in licaltli, and 
constitute a normal, necessary part of its elements. 
But ■\vliin tlie tissues arc separated from tlieir vital 
connections and exposed to the air, these pinnules at lirst 
arranjre tliemselves in strings, and finally assume the 
shape of moving or motionless roils, presenting all the 
appearanre of the vihriones known as bacteria and bac- 
toridia, and described by Daraine.* Fragments of 
liver placi'd in water containing either sugar or starch, 
showed a development uf bacteria in twenty-four hours. 
But if immersed in ordinary water, the development 
•was delayed five to tliirteen days. Further, what is 
extremely important to notice, the addition of creasote 
or of phenio acid in no wi.se afleeted this prohferation 
of animal germs, unless it were made in a quantity suf- 
ficient to coagulate animal tissues. Tiiat these bacteria 
came from the microzyme-5 into which tliey were seen 
to grade, iind not from the suirounding air, .seems proved 
by the fact that they were always discovered in the 
fragments of tissue before they appeared in the water 
in which these were immersed. 

In the QiimierJ;/ Jotirnal of Microscopical Science for 
last October, Burdon-Sanderson has shown, by most 
c.irefid experiments, that the microzymes never come 
from the air. According to this writer, they frequently 
abound in water, so that a drop or two of ordinary 
spring water added to a test solution is sufficient to de- 
termine in it the development of microzymes and of 
bacteria. But if the water so added be boiled and the 
whole placed in a gla-s that has been superheated, no 
microzymes will appear, even though the liquid be left 
exposed to the air. In the latter case, however, toru- 
la-cells appear in as great abundance as if the liquid 
had not been boiled. It is thus shown that no connec- 
tion exists between the microzymes destined to develop 
into bacteria and the torula-cells that multiply into 
fungi. The air is charged with these latter, while the 
former abound in animal and vegetable solids and fluids. 

To test the influence of bacteria, apart from that of 
the morbid fluids with which thej^ were a.ssociated in 
Davaine's experiment-, Leplat and Jaillard t injected 
the veins of animals with fluids containing bacteria ob- 
tained from decomposing vegetable infusions. Such 
injection- were productive of no inconvenience what- 
ever. Analogous experiments were made by J. G. 
Richardson, as related in the American Journal of 
Medical Srimces for July, 18G8, p. 291. He swallow- 
ed from one to four fluid ounces of Avater, rendered 
putrid by two or three days' contact with meat, and 
swarming with vibriones. A drop of blood drawn 
half an hour after the ingestion of one fluid ounce, pre- 
sented only a single vibrio. But Avith a k'ger dose 
and an hour's interval the number greatly increased. 
Twelve were seen in as many minutes, and at one time 
there Avere three in one field. In tAvo hours, however, 
these had entirely disappeared, their presence in the 
blood having occasioned no other inconvenience than 
plight headache, furred tongue, and some diarriioea. 

Thus, left to themselves in contact with healthy liv- 
ing tissues, vibriones are rapidly eliminated without 
causing any damage. MoreoA'cr, as Davaine observ^es, 
in a medium composed of substances in full putrefac- 
tion, these animalcula are also unable to sustain life. 
They live upon organic matter that is just beginning to 
decompose ; they eannot determine the decomposition 
of living tissues ; their germs cannot develop to the 
potency of bacteria unless they have free access to 
oxygen ; finally, when the organic matter in Avhich 
they are imbedded is dead, and I'csolved into inorganic 



* Dictlontiaire des Sciencen Medfcales, Art. " Bacteries." 
t Comptes Rendus de FAcademie des Sciencen, 18G7. 



elemenl.s, the vibriones die too. Hence, though Feltz 
and Cohn have discovered tln-m in the fluids of putre- 
fying Avounds ; though Ranvier hns.found them nea?' 
the seat of a fractured bone affected Avith osteo-myelitis; 
though he has further found germ -granules in meta- 
static ab.scesses, — yet these marvellous little orgaidsms 
cannot be rendered directly chargeable for all the acci- 
dents of putrid and purulent infection ; nor their de- 
struction be considered an assurance of security against 
these formidable complications of Avounds. For, Ist, 
in air that has been sufficiently purified to avert cer- 
tain forms of disease, as hospital gangrene and the 
more malignant kinrls of septica?mia, the germinal mat- 
ter of vibriones is still found in considerable abundance, 
so that animal fluids or tissues exposed to the air ne- 
cessarily decompo.se. 

"id. I'ositivc experiments have shoAvn that Ixacteria 
by themselves, though introduced into the blood, are 
not injurious. Further: Bergmann has shown that the 
dried residue of pus retains its toxic properties, though 
it have been heated to 212', or treated by alcohol of 96 
per cent. ; and either procedure is accounted suflQcient 
to destroy animal germs.* 

The above-quoted experiments of Burdon-Sanderson 
tend to show that the vibriones of the air, which are a 
cause of putrefaction, dilTer essentially from the micro- 
zymes of nnimal fluid:^, whose development may be 
only an effect. But the deA'clopment of these latter 
to bacteria may act like that of all other vibriones, in 
favoring putrefaction. Hence the accession of air to a 
wound woidd work in tAvo ways: it Avould admit at- 
mospheric germs, demonstrated agents of putrefaction; 
and it Avould furnish the oxygen requisite for the de- 
velopment of microzymes, probable agents of putrefac- 
tion. The one and the other class of vibriones — innocu- 
ous if themselves absorbed — only act by determining 
the alteration of traumatic fluids ; and these once alter- 
ed become toxic, though the causal germs be excluded 
or destroyed. 

That the accidents resulting from Avounds depend 
upon the introduction into the economy of substances 
formed uptm them is shown : (a) because the artificial 
introduction of these same substances, by injection into 
the veins, is followed by the same symptoms as occur 
spontaneously Avhen they are left long in contact with 
living membranes ; (h) because direct expeiiiuent proves 
that the capacity of absorption from the surface of 
Avounds is very great. 

Two gieat classes of infection may be formed: 1st. 
That Avhich depends upon primary absorption from the 
wound previous to the groAvth of gramdations or the 
formation of pus; 2d. That which supervenes after 
suppuration, and the complete disappearance of trau- 
matic fever. » The first class constitutes septica3mia ; the 
second, pya-mia, or purulent infection. 

It is noteworthy that septicaemia is developed at a 
time Avhen absorption from the wound is slowest; 
pyaemia, Avhen it has begun to be most active. De- 
marqua}' has shoAvn that an iodic solution placed on a 
lecent wound will be absorbed in from fifteen minutes 
to an hour. But after application to a granulating 
wound, iodine may be detected in the urine and saliva 
in ten, eight, six, or even four, minutes. It would seem, 
therefore, that the accidents of septica;mia depend on 
the absorption of some substance more diffusible than 
that Avhicli is the origin of pysemia, since it acts more 
quickly, though at a time Avhen absorption is less 
active. 

The Avounds in which pure septicsemia originate^ may 

* On this last point, however, there is at least room for doubt, since 
Wyman's experiments (A7n. Jour. Set., 1867) have shown that certain 
infusorial germs will retain their vitality even after four hours' boiling. 



THE MEDICAL RECORD. 



affect exclusively the soft tissues. Thus, in wards where 
pyoemia was the most frequent disease, I have seen 
septicaemia develop as a consequence of an operation 
for a double prolapsus of the uterus and rectum, where 
an attempt was made to extend tlie perinanim b;ick- 
wardfi by a suture that sliould include a part of the 
enormously distended anal sphincter. 

Septicajmia is frequent after operations for stranf^u- 
lated hernia or the extirpation of tumors, and often 
complicates the peritonitis occasioned by ovariotomy. 
But in wards where pyi\;mia and septicemia were both 
endemic, I have been struck with the exemption of pa- 
tients wlio had suffered amputation of the mammary 
gland. On the other hand, the extirpation of a fibro- 
plastic tumor from the deltoid muscle was followed by 
a typical development of septicaemia. The traumatic 
fever set in within twenty-four hours after the opera- 
tion, and, instead of abating, persisted, and gradually 
rose into all the violence of the septicasmic fever. 

This form of surgical fever is frequent as a conse- 
quence of diffused acute phlegmon of cellular tissue, 
even when this is unaccompanied by osteo-myelitis. 
It constitutes those peculiarly malignant forms of puer- 
peral fever where death supervenes with great rapidity, 
and where, after death, the uterus presents no trace of 
phlebitis or of lymphangitis. These cases are excep- 
tional. 

It is a very remarkable circumstance that gunshot 
wounds, so excessively dangerous when they affect 
the bones, are so frequently innocuous when confined 
to the soft tissues. I had abundant opportunity for 
observing this fact in the case of numerous shell 
wounds that came under my observation during the 
siege of Paris. In wards where acute diffused phleg- 
mons frequently proved fatal by generating septicaemia, 
flesh-wounds caused by the explosion of shells healed 
readily, even though, as in one case, the victim was a 
woman six months pregnant, and miscarried after a 
triple injury in face, thigh, and leg. 

A curious case of impunity, even though the bone 
was involved, was that of another woman Avho had 
been for four years an inmate of the hospital on ac- 
count of chronic rheumatism in shoulder, Avrist, and 
knee-joints, all of which were more or less completely 
ankylosed. During the bombardment, a sliell exploded 
in the hospital ward, and carried off this patient's right 
arm about three inches below the shoulder-joint. It 
was a very clean amputation, with very slight htemor- 
rhage ; and but little trimming of the wound was need- 
ed to make a neat stump, which was speedily covered 
by fleshy granulations. Not merely did the patient 
escape without any signs of septicaemia or purulent in- 
fection; she even had no traumatic fever. I attributed 
this remarkable exemption to the pre-existence of 
chronic adhesive inflammation, which had rendered the 
tissues — lymphatic, cellular, osseous, and to a certain 
extent even the veins — impermeable to the septic ma- 
terial arising from the traumatism. 

The behavior of gunshot flesh wounds resembles 
that of those made Avith caustics as compared with 
those made by the bistoury. It is not my province to 
insist upon the practical advantages of the method so 
eulogized by Maisonneuve, but their bearing upon the 
theory of septic and purulent infection is of importance. 
The facts tend to show that tissues kihed outright, by 
chloride of zinc or the actual canter}', present far less 
chances of infection than those that die slowly and, 
during a long period, offer to absorption the successive 
products of their decomposition. Tliey appear, more- 
over, to block up the roads of absorption, and not to 
afford the media for diffusion constituted by loose dif- 
fluent tissues. 



Septic absorption occurs to a greater or Jess extent 
whenever decomposing animal matter is brought in 
contact with living me[nbranes, and seems to be inde- 
pendent of the state of the veins. 

The condition of the lymiihatics is of much more 
importance. For at the lime that septicaemia develops, 
the lymphatics, torn by the traumatism, gape open into 
the wound, while later they are closed by Hesliy granu- 
lations. Septicaemia, which precedes the formation of 
these granulations, likewise, in typical cases, precedes 
the formation of pus. This does not normally occur 
before the third da}'; and if symptoms of septic poison- 
ing have appeared previous to its establishment, sup- 
puration may be indefinite!}' delayed, or the pus be le- 
placed by a thin sanious liquid, in which pus-corpuscles 
aie rare. According to Robin, the decomposition of 
pus is always a consequence of the generalized infec- 
tion, and not its cause. 

As might be inferred from this appaient connec- 
tion with the lymphatic system, the full develop- 
ment of septicaemia is often preceded by a lymphangitis. 
But it is extremely curious to notice that, should this 
lymphangitis be inmiediately followed by tumefaction 
or phlegmon of the nearest lymphatic glands, or by an 
attack of erysipelas, the general infection seems to be 
averted. I have in my notes three eases of compound 
injuries of the fingers, followed by abscess in the 
axilla, Avhich in one case had been preceded by a subacute 
phlegmon of the arm ; in another, by the red streaks 
of superficial lymphangitis ; in the third, by a probable 
affection of the deep lymphatics. All these cases re- 
sulted in recovery, in the same wards Avhere patients 
affected with quite similar injuries were constantly 
succumbing with symptoms of septico-pytemia. The 
occurrence of erysipelas seems also frequently to 
ward off the graver affection. In two cases of carbun- 
cle treated by extirpation, the occurrence of a chill, 
in connection with a sudden drying and glazing of the 
wound, was regarded as an ominous forerunner of 
Septic infection, until the advent of a local erysipelas 
unexpectedly changed the prognosis. In another case, 
an operation for strangulated hernia in a woman was 
followed by an attack of erysipelas on the face, from 
which the patient recovered. She subsequently suc- 
cumbed to exhaustion, but never presented either 
symptoms or lesions of putrid or purulent infection. 
These fivcts, and certain statistics showing the epide- 
mic alternation of erysipelas with gr-aver surgical aftec- 
tions, bear testimony" in favor of the theory that ascribes 
erysipelas to a diffused inflammation of the lymphatics 
of the skin, caused by the passage through them of irri- 
tating substances. It is upon this theory that Maison- 
neuve has based his treatment of erysipelas by appli- 
cation of a blister directly to the inflamed surface, for 
the purpose of drawing off septic material in a profuse 
discharge of serosity. 

The "succession of symptoms in septicremia gen- 
erally occurs as follows : The traumatic fever, instead 
of abating, persists, or abates only imperfectly. The 
suppuration, that should have set in on the third day. 
is delayed ; and sometimes the wound becomes glazed 
and dry, or points of gangrene appear in tissues that 
seemed at first sufficiently vitalized. Sometimes, as 
was the case with the patient submitted to a perina.>or- 
rhaphy, a fugitive local erysipelas appears, to disap- 
pear after a few hours. About the fourth day occurs 
a single chill, often quite violent, immediately follow- 
ed by a notable lise of temperature. By the fifth day 
the sutures in the wound give way, and the tissues 
begin to melt down into an increasingly putrescent 
detritus. At the same time the pain of the wound is 
diminished, and this local blunting of the sensibility 



7G 



THE MEDICAL RECORD. 



rapidly extends to tho entire nervous system. The 
patient becomes absorbed, indifferent, finally agitated 
and delirious. The delirium is sometimes muttering, 
oIUmi violent. The fever is remarkable for iUs eontinu- 
aiiei- ; uiorninc^ remissions are slip;ht. Under this eon- 
tinued fever tlic body emaciates; tlic clieeks become 
excavated, and covered with a dry parched flush ; the 
eyes are injected ; tho tongue and lips retracted and 
blackened ■with fidiijinositirs; the whole aspect of the 
patient recalls that of typhoid fever, and the occurrence 
of diarrhoea completes tlie resembhinee. 

The peculiar circumstance about the jjathological 
anatomy of pure sei)tic8emia is its negative charac- 
ter. There is no trace of phlebitis, thrombi, or me- 
tastatic abscesses. The veins arc all permeable, but 
filled with diflluent black blood like molasses. The 
viscera are neaily all soltened and congested, as in 
typhus. 

In artificial sejiticajmia, induced by the injection of 
putrid matters into the veins, there is often diffused 

f)neumonia, cr there may be patches of gangrene in the 
lings. The most notable lesion, however, exists in the 
intestinal mucous membrane, which is tumefied, hyper- 
aemic, and soltened. This lesion corresponds to the san- 
guinolcnt diarrhoea, which is an invariable symptom 
during life, and both lesion and symptom point to an 
effort at elimination of tlie poison by the intestinal 
tube. That the lesion is so extremely marked in ani- 
mals, while it is slight or Avanting in human victims, in- 
dicates that tlie effort at elimination is greater in the 
former case than the latter, and helps to explain, there- 
fore, the greater resistance of dogs to the disease. 

Finally, a very notable peculiaritj^ of septicnemia 
is its variable degree of intensity — variable as the con- 
ditions which may give rise to it. There is the terrible 
septicemia of malignant forms of puerperal fever, that 
destroys life in a few days; there are the much milder 
Ibrms, t'.iat almost invariably occur when decomposing 
animal fluids are brought in contact with any surface ot 
the body in such a way that any part of them may 
be absorbed. The retention of a piece of the placenta 
in the uterus will give rise to all tho symptoms of an 
incipient septic fever, as I had an opportunity to observe 
in a ease the other day. Nay, even in perfectly normal 
conditions, recent accurate observations have noted a 
rise of temperature as a general occurrence about 
twelve hours after parturition. This phenomenon is 
precisely analogous to the well-known traumatic fever, 
and the elementar}- conditions are the same, namely, 
the contact of decomposing non-purulent fluids with 
living membranes capable of absorption. 

In these cases, the general disease seems to be 
directly connected with the wounds, and this, not in 
virtue of the nervous shock they have inflicted, but of 
t'm decomposing liquids, or of some element in them, 
that they place in contact with live animal membranes. 
The essence of the general disease lies in the fever, or 
rise of temperature; and of all the causes that have 
been invoked to explain the rise of temperature in such 
cases, that of an acceleration of the molecular metamor- 
phoses of the blood and tissues is infinitely the most 
probable. For the fever may be determined, either, 
as I have said, by contact with animal membranes 
of substances themselves undergoing rapid chemical 
metamorphoses, or by an injection of these same sub- 
stances into the blood, as in Billroth's experiments.* 
In these experiments there was no chill, but tlje tem- 
perature rose immediately as liighas 40.5" C, and other 
symptoms of septicaemia followed, as diarrhoea and 
great prostration. Recovery frequently took place. 



' Archiv far Klinische CMrurgie, 1862. 



In some cases, where the amount of injected material 
had been very large, death occurred, and then the 
only visceral lesions discoveral.lc were diffused conges- 
tions, especially of the inU'slinal mucous membrane. 
From these experiments the gravity of septicasmia 
is .«hown to be in direct ])roportion to the amount of 
putrid nuUters thrown into the blood, although in every 
case they determined a rise of temperature. IJelow a 
certain limit of (paantity, they could be supported; but 
above that limit, they occasioned more violent symp- 
toms, which finally proved fatnl. This gradation corre- 
sponds to that furnished by clinical experience — to the 
immense variety in the severity of septicaemic symp- 
toms, which are least of all after normal parturition ; 
greater alter wounds, and in proportion to their extent ; 
greatest of all when, long alter the original shock, new 
tissues have sloughed by the invasion of hospital gan- 
grene. There are, therefore, the strongest reasons for 
accepting the recent doctrine of I3illrotli, which inter- 
prets traumatic fever as a form of septicaemia, and .septi- 
caemia as a simple extension or aggravation of traumatic 
fever. 

Tliis analogy suggests that of numerous other affec- 
tions in which septicemia pla3's a prominent part, as 
hospital gam^rene, carbuncle, malignant pustule, typhoid 
fever, variola, ulcerative endocarditis, even erysipelas 
when the effort at cutaneous elimination has proved 
unsuccessful. In all these cases the evolution of the 
affection seems to be connecteil Avith the presence in 
the blood of rapidly decomposing substances, whose 
metamorphoses accelerate those of the animal tissues, 
including the blood, and thus raise the temperature of 
the body. 

It is in virtue of this rise of temperature that septicae- 
mia is allied to pyaemia; lor the injection of pus into 
the veins, even when it produces no other effect, gen- 
erates fever as intense as that jiroduced by the injection 
of putrid non-purulent fluids — fever which may end in 
death. In other resjiects the symptoms and march of 
pyaemia are quite different from those of septicaemia. 

As every one knows, pyajmia originates most fre- 
quently in some lesion of bones, which places the 
wounded osseous tissue in immediate communication 
with the air. The larger the bone, the greater the 
danger, which is most to be dreaded after injuries of 
the femur. Who is not liamiliar with the train of events 
that, in such a fatally large number of cases, follows 
upon an amputation of the thigh? The patient may 
have recovered from the initial traumatic fever, and 
on the fourth or fifth day be apparently in very good con- 
dition. Suppuration, which set in on the third day, be- 
comes profuse, but the pus remains thick, yellow, lauda- 
ble, or only slightly offensive in smell. Thus, suppura- 
tion precedes the invasion of pyemia, while the symp- 
toms of teptica^mia generally begin before the establish- 
ment ofsuopuration, or arrest it if pus be already form- 
ed. 

The wound is extremely painful, and its sensitiveness 
seems to increase instead of diminishing. The process 
of dressing the wound throws the patient into an 
agony ; but when this is over, he is comparatively com- 
fortable, often extremely hopeful and sanguine. One 
day, generally between the fifth and tenth, the nurse 
observes that the patient has eaten less than usual. In 
reply to inquiries, however, he asserts, sometimes quite 
vehemently, that he is perfectly well. A day or two 
later he acknowledges having had a slight chill or 
fever, that he refers to only on account of the persistent 
questionings of the surgeon. Sometimes several days, 
even a week, will elapse before the chills are repeated ; 
sometimes they follow in rapid succession, coming 
every day, or even twice and thrice a day. It is ex- 



THE MEDICAL RECORD. 



77 



tremely rare that only one chill precedes the invasion of 
fever ; and even then, this invasion only occurs after 
a certain interval. The chills are very apt to return 
after the establishment of fever, and checker its course 
in a way never seen in pure septicajmic infection. 

The rise of temperature occurs sometimes after tlie 
complete subsidence of the traumatic fever, in notable 
contrast witli that of typical cases of septicaemia. It is 
rarely as rapid, as intense, or as continued as in the 
latter case ; for some time it presents very marked 
morning remission, and only gradually rises into con- 
tinuity. 

The appetite and strength fail, and the patient is 
conscious of his increasing weakness, and complains of 
it, as is never the case in septicjemia. Hence it seems 
much more notable. The skin and sclerotics assume 
the characteristic yellow hue, extremely unlike the red 
parched flush of septicaemia, and analogous to that of 
cancerous infection, with which Bihroth compares it. 
It is one of the forms of jaundice described by Gubler, 
dependent on a destruction of red corpuscles in the 
blood. The tongue of the patient becomes dry, but 
never blackened by fuliginosities as in septicaemia. The 
intelligence remains clear, but the mind begins to be 
darkened by gloomy forebodings, by a semi-conscious- 
ness of the dissolution of vital forces already begun. 

During this time the aspect of the wound is little 
changed, the suppuration is abundant, according to 
Billroth is increased, and my own observations accord 
with this statement. An extension of suppuration 
takes place, as the older writers would say, and is mani- 
fested in one or more of three different ways. 

In the first place, cold abscesses may form in differ- 
ent parts of the cellular tissue, generally of the extremi- 
ties, sometimes in the more decumbent portions of the 
trunk. In the second place, purulent eflfusions njay 
take place into the articulations, or serous cavities, and 
that with extraordinary rapidity. This pin'ulent ar- 
thritis is a very common manifestation of infection dur- 
ing the puerperal state. I remember one case especiall)^, 
which I had an opportunity of observing at tlie cliniqne, 
that might be considered as a type of this class. The 
patient had had an attack of subacute metritis, wiiich 
was subsiding, when she complained of pain in her It-ft 
elbow-joint ; and in the course of tweniy-four hours the 
articulation became evidently filled withlic[uid, swollen, 
extremely tender, but without any inflammatory red- 
ness. The only other symptoms presented by the 
patient v/ere diarrhoea, and a certain dulling of the in- 
telligence. M. Depaul immediately pronounced a fatal 
prognosis, which was justified four or live days later by 
the death of the patient with all the symptoms of 
purulent infection. 

These external suppuration-s, however, indicate a com- 
paratively curable form of the disease, and, when mani- 
festations of the infection are confined to the cellular 
tissue or the articulations, the patient may recover. I 
have seen three curious cases of this categor3^ After 
a compound fracture of the tibia, a patient was affected 
with cold cellular abscesses in various parts of the body, 
and with purulent effusion into one of the knee-joints; 
yet he ultiuiately recovered. 

In anotlier ca^-e, also of compound fracture of the 
tibia, the patient had had three chill--, and an abscesr; 
had developed in the thigh. After the administration 
of quinine, the course of the infection seemed to be 
arrested, and the patient recovered. 

In a third case, the purulent infection had origi- 
nated in an anthrax, which had been followed by 
abscesses in the breast, gluta^al region, and leg, and by 
an effusion, probably purulent, in the knee-joint. 
Notwithstanding this multiple suppuration, the patient 



recovered, and the articular effu.sion was reabsorbed 
with the rapidity so remarkable in such cases. 

These cases recall the experiments of Sedillot upon 
dog'j, where injeclion of pus into the veins was fol- 
lowed by the development of external abscesses, but 
finally by recovery. 

External suppuration or suppura'ive inflammation of 
serous cavities may, however, of itself prove fatal, as in 
a case that I saw at the Children's Hospital, where 
purulent infection is comjiaiatively rare. A child four 
years old had been submitted to Chopart's amputation 
of the foot, on account of a fungous arthritis, accom- 
panied by necrosis of some of the medio-tarsal bones. 
The first few days after the operation passed very well; 
then secondary fever set in, and was followed by sj'-mp- 
toms of arthritis in both elbow-joints, and of double 
pleural effusion. Death occurred about a fortnight 
after the operation, and at the autopsy were found 
.abundant purulent effusions in the articulations, in both 
pleural cavities and in the peritoneum. This purulent 
peritonitis had been latent and quite painless, and had 
probably taken place during the last days of existence, 
when sensibility was blunted. There were no traces 
of metastatic abscesses in lungs, liver, or spleen. 

These metastatic visceral abscesses constitute the third 
form of generalized suppuration, and the lesion most 
characteristic of pytemia. The invasion and march of 
the disease seems to coincide exactly with their devel- 
opment and evolution. To them is due the dyspnoea 
that occurs early in the disease, while that of septicaemia, 
dependent on the poisoning of the mass of the blood, 
does not supervene till later. The respirations are 
rarely below forty, sometimes as high as fifty or sixty. 
With the progress of one or the other of these suppu- 
rations, the prostration of strength increases. All the 
powers of life seem to be graduall}^ dissolved apart 
irom one another, and drift away separately before 
sinking down into the sea of nothingness that is rising 
to engulf them. Hence towards the close, a peculiar 
incoherence of the mental faculties and of speech, that 
is quite distinct from the delirium of septicaemia. The 
patient will interpolate absurdities in the midst of a 
conversation whose general tenor is reasonable ; he 
has tempoi'ary hallucinations of vision ; he loses all capa- 
city for comparison, and consequently for astonishment ; 
his mind resembles that of a person in the incipient 
stages of dementia. 

This ataxia of the intelligence finally extends to the 
spinal and peripheric nervous system ; there is carpholo- 
gia, the wandering involuntary movements by which 
the patient seems vainly endeavoring to clutch at the 
life that is slipping away from him. Finally, conscious- 
ness is entirely gone — the patient lies on his back with 
his eyes closed, already half a corpse. I have seen one 
case where this condition was prolonged a month, and 
Mr. Paget relates similar cases of chronic pyaemia, 
where, as in Edgar Poe's story, the patient seems to 
have been magnetized when at the point of death, and 
his dissolution arrested, but left constantly imminent. 
It is during this last period that the suppuration on the 
wound diruinishes. 

The autopsy of patients who have succumbed to pyte- 
mia reveals one or other of three charactf'ristic lesions, 
and very frequently a combination of all of them : osteo- 
myelitis ; venous thrombi, with or without phlfbitis; 
visceral abscesses, or purulent effusions into the articu- 
lations or serous cavities. 

The osteo-myelitis, whose presence might have Ijeen 
inferred from the constancy with which pyaemia is as- 
sociated with lesions of the bones, is extremely fiequent. 
M. Ranvier, in an article published in the Lijons Mid- 
iaile for last May, observes that he found it in all the 



•8 



THE MEDICAL KECORD. 



Riitopsies made at Val de Grace durin;^ tlie siege. M. 
Gos>-^elin, ill his clinical lectures, always insisted upon 
this coincidence, an<l has rt'lencd to it again in the re- 
cent discu.-sion at the French Acadrmy. I have cer- 
tainly had abundant opportunity to ohscrve it myself. 
"* This osteitis is always of the rarclyiufj; variety; the 
bony tissue is hifrldy vascidarized, and ihe surface of a 
section shows the tral)ceulie to be red and softened, and 
the spaces they enclose enlarged, and filled with gru- 
mous sanguinolent matter. The medullar}- canal is filled 
villi a vascularized pulpy mass, whence the lat has dis- 
appeared, a most noteworthy circumstance. A very 
characteristic detail is the projection of a portion of the 
mass from beyond the medullary canal. 

Of Ie?s importance for the pathogeny of pyaemia is 
the thickening of the periosteum, and its frequent de- 
tachment from the bone by neoplastic material formed 
beneath it. 

There are two noticeable facts al)oiit a bone in this 
condition : 1st. That all its cavities, both the medullary 
canal and the spaces between the trabeculae, instead of 
being obstructed by solid clots, are filled with loose, 
pulpy, diffluent matter, exactly calculated to offer a me- 
dium of diflfusion for liquids carrying solid particles in 
suspension, lid. That the fatty matters of the me- 
dulla, so eminently adapted to rapid movements of 
chemical metamorphosis, are as ready for absorption as 
are the liquids on the surface of the original -wound. 

Not only is osteo-myelitis an almost invariable at- 
tendant on fatal cases of compound fracture, but it may 
constitut,^ the sole perceptible cause of ])ya;mia, as 
v/hen the latter supervenes upon an acute necrosis 
(so calleii), or even, under certain circumstances, upon 
sinif)le fracture. I have observed an example of py- 
aemia in an old man affected with simple fracture of 
the neck of the femur whicli had begun to consoli- 
date when he succumbed to the afiVction, at that time 
endemic in the ward. Billroth quotes a similar case; 
and Prescott Hewett records a third in the Lancet for 
1867. 

In ano'her instance that I have seen, the pvicmia 
supervened upon a chronic otitis, accompanied by caries 
of th i petrous bone. In all these cases, metastatic 
abscesses were formed in the lungs. 

The second lesion that may be found in pyajmic au- 
topsies is phlebitis. Billroth observed it twunty-eight 
times in eighty-four cases. As is well known, it is to 
phlebitis that Berard ascribes all the phenomena of pu- 
rulent infe':tion. The apprehensions of dangi^r from this 
cause have been much diminished since Virchow has 
shown that the coagulation of blood in the veins is not 
its consequence but its cause, and that irritation direct- 
ly applied to empty veins inflames the external coat, 
but leaves the inner tunic untouched. The inflamma- 
tion of the inner coat is always a consequence of the 
softening of the coagulum i.hat ha^ formed in the cavity. 

This softening, or suppuration as it has bei n called, 
takes place in two ways: 1st. By the molecular disin- 
tegration of the fibrin. 2d. By the penetration into its 
mass of pus ci-lls, or white blood-corpuscles, that have 
wandered from blood-vessels or from purulent collec- 
tioi^ in the neighborhood of the thrombus. Ilueter, in 
his chapter u\^DiUro(h and PitluCs Sur;/er?/, does not 
hesitate to admit this penetration, and considers it 
proved: (a.) By Cohnheim's experiments on the capa- 
city of white biood-corpuscles to traverse the walls of 
capillaries and blood-vessels, (b.) By t'.iose of Eeck- 
linghau-en, published in the Archiv of Vircliow, and 
whicii show the contractility of pus cell?, and of cells 
ofconnec'ive tissue, (c.) By the experiments of Bub- 
nofi; recorded in tiie Centralblatt, of 1867, there has 
been directly observed the passage into the thrombus 



of pus cells that had previously taken up granules of 
cinnabar. In this connection we may inquire whether 
the presence of the granules did not communicate a 
force of impulsion to the cells that they otherwise 
would not have pos.sessed ; and whether, therefore, pus 
cells that had become granular by commencing decom- 
position, would not be able to penetrate where others 
were shut out. 

When, by the medium of a phlebitis, inflammation 
may be propagated from the wound to ti.ssues of vital 
importance, the softening of thc'clot may prove imme- 
diattdy fatal. In the Ai'chires Grnh-'ihs for 1871, 
Kcverdin has pointed out that in anthrax of the face, 
inllamniation of the fai'ial veins may extend to the sinus 
of the dura mater, and excite a fatal meningitis. 

Except in such special circumstances of contiguity, 
phlebitis remains a purely local affection, not only in 
such ty[)ical cfises as that of inflamed varicose veins, but 
also in others where it seems to substitute itself for a 
general disease. Thus, during an epidemic of so-called 
puerperal fever, the patients affected with a well-defin- 
ed metiitis, or phlegmasia alba dolens, generally escape 
peritonitis or septic infection. Even the phlebitis that 
seems to have been generated by transport of pyroge- 
nic material from a distant wound, may result in recov- 
ery, without signs of infection. I have seen one case 
where the extirpation, for cancer, of a mammary gland, 
was followed by phlebitis of tlie right leg — a real phleg- 
masia alba dolens, which retarded, but did not prevent 
recovery. So marked is the opposition between local 
adhesive phlebitis and pyaemia, that Sedillot treated in- 
cipient cases of the latter disease by cmterization over 
the veins leading from the wound, for the purpose of 
exciting inflammation and an effusion of plastic mate- 
rial that should erect a barrier against the absorption 
of putrid substances, or, as Sedillot maintained, of pus. 

When the fibrinous coagulum remains hard, and 
obliterates the vein, no phlebitis ensues, as may be seen 
in ordinary varicose veins, or in the inopexia of cachec- 
tic diseases. The inflammation of the inner coat of the 
vein, as I have said, only occurs when the process of 
.softening of the clot has extended the cavity first hol- 
lowed out in its centre, to the membrane limiting its 
periphery. It is infinitely probable that this process, 
which causes the phlebitis, is itself the cause of acci- 
dents of which the phlebitis is only an incident, because, 
on the one hand, these accidents coincide with the 
softening of thrombi, when little or no phlebitis exists; 
on the other hand, there are very rarely accidents with 
a less degree of softening, and a very intense degree of 
phlebitis. 

The question of the influence of phlebitis in pyaemia 
resolves itself, therefore, into two others: 1st. The 
formation of thrombi ; 2d. Their disintegration. 

Now it is extremely noticeable that many of the cir- 
cumstances whicli favor the development of thrombi 
are precisely those which seem almost essential to the 
development of pyajmia. As Weber observes, since 
every traumatism involves a solution of continuity of 
veins, and since this is necessarily followed by a coa- 
gulation of blood in their interior, the formation of 
thromli is a necessary consquence of eveiv wound. 
But in superficial wounds of the soft tissues, the vessels 
are small, and easily obliterated at their extremities. 
When larger vessels are torn, one of two things hap- 
pens : Either the vessel flattens together above the clot, 
obliterating its extremity, and then the thrombus never 
projects into a free cavity; or the clot is prolonged as 
far as the nearest collateral vessel, and its extremity 
floats free in the stieam, and in a space larger than its 
own diameter. When this last occurs in arteries, as is 
( normally the case af er ligature, no harm result*, because 



THE MEDICAL RECORD. 



79 



the sti-eam of Wood is not coming from the collateral, 
but passing down into it, and if any fragments are s^epa- 
rated from the fibrinous clot they must be carried 
down to anotiier point on the periphery of the vascular 
system. But in the case of a vein the conditions are 
reversed; the coUateral current comes from the pei'i- 
phery, strikes the floating end of the coagulum, breaks 
off a fragment, and carries it towards the heart and 
lungs. 

Of the conditions which favor the disintegration of 
ihe thrombus, the first, therefore, are those wliich expose 
its free end to be broken ofl" mechanically. These con- 
ditions are two : length of the coagulnm, and such a 
structure of the tissue surrounding the veins as is op- 
posed to their collapse. 

The length of the coagulum is increased: 1st. By 
whatever increases the amount of fibrin in the blood, 
or rendei' its circulation sluggish, as abundant haemor- 
rhage, exhaustion from previous disease, privation, or 
old age. Weber attributes the rarity of true purulent 
infection among children to the activity of their circu- 
lation, which restricts the formation of thrombi. 2d. 
By the absence of valves in the veins. .3d. By the 
sudden suppression, through amputation, of an exten- 
sive vascular territory. 

The two latter conditions are presented by the veins 
in the long bones, the last especially after amputation of 
the thigh, where, as is known, the liability to pyaemia is at 
its maximum. 

In os-eous tissue, and especially in that of the long- 
bones, is also found the second general condition favor- 
ing long cnagula, namely, a structure that prevents 
the veins from collapsing. Lining the pores of the 
bones, they are necessarily maintained distended, and 
this circumstance, which has been wrongly sup- 
posed to imply such gaping open into the wound as 
should permit the direct entrance of solid particles, 
really favors the formation of lengthy coagula, with all 
their consequences. The same condition may be pre- 
sented by the sinuses of the uterus when that organ 
fails to contract sufiiciently after parturition. Here 
again are no " open mouths," but tortuous vascular 
canals, in which collateral currents meet and cross 
each other in every direction, filled with loose fibrin- 
ous clots that offer media for diffusion, and are liable 
to disintegration. 

The circumstances that favor the disintegration of 
the clot throughout its mass, constitute the second class 
of conditions which render thrombi dangerous. 

1st. First among these is the osteo-myelitis, which 
Ave have already noticed as so generally existing in 
fatal cases of pyaemia. The local activity of the cir- 
culation, uncompiensated by sufficient force in the cen- 
tral part of the system, on the one hand determines 
serous effusions into the clots; on another, creates 
collateral cvu-rents ready to carry down stream the 
fragments resulting from the disintegration. This effect 
is added to that proper to the inflammation itself. 

2cl. The softening of the clot is favored by the 
penetration into its mass either of pus cells already 
effused elsewhere ; or of white corpuscles directly 
passing from the neighboring blood-vessels; or, finally, 
of putrid liquids. We have noticed that the penetra- 
tion of pus cells, which could not in any wise be con- 
sidered a phenomenon of absorption, would be prob- 
ably favored b}'' their granular and angular condition ; 
and as this is peculiar to decomposing pus, the influence 
of the latter may be in part explained. As to the 
white blood-corpuscles, with Avhich we have seen that 
a certain proportion of pus cells may be identified, the 
f;T0st common condition of their transudation is their 
previous stasis in capillaries, Avhich has long been 



known to be one of the initial phenomena of inflam- 
mation. The well-demonstrated influence of intense 
local inflammation upon the development of pyocmic 
accidents, is thus in part accounted for by the pene- 
tration into the interior of thrombi of pus cells existing 
in the neighborhood. When such elements come fi'om 
the tissues suirounding the thrombus, they penetrate it 
in virtue of the contractility demonstrated by Cohn- 
heim and Recklinghausen. But, if they ever come 
fi-orn the surface of the wound — that is, penetrate fiom 
without inwards — they are diffused like other solid 
particles in the liquids which iiold them in suspension. 

Since, after the closure of the lymphatics, there are 
no open-mouthed vessels gaping into the wounds, and 
consequently the absorption of pus as such is impos- 
sible, this diffusion from the surface of the womid is 
regulated by the general laws of diffusion. Thus it 
will be greater Avhen there is a stronger pressure with- 
out, such as may be exercised by tissues rendered 
tense by inflammation or by fibrous aponeuroses, and 
when this is combined with a diminution of the pres- 
sure within, as by a lowered tension in the blood- 
vessels. A liquid difiuses more easily when it is less 
dense, and especially when it contains less colloid or 
albuminous substances. Hence the thin sanious fluids 
first formed on wounds may be expected to diffuse 
more readily than thick pus, rich in albuiuen ; and this 
corresponds to the fact already noticed, that septicsemia 
precedes the formation of pns, and seeius due to toxic 
substances more diffusible. A granulated condition of 
the pus cells may favor their penetration. Finally, 
a'icording to Sachs, the protoplasma of cells has a ten- 
dency to retain the solid particles of liquids that difluse 
into them, so that these grow less and less dense as 
they traverse successive layers of cells. With each de- 
crease of density, or diminution of solid particles, the 
diflusing power is heightened, and the fluids that have 
once traversed the outer barrier of tissues, pass with 
continually increasing rapidity towards the interior of 
central canals or vessels. The ultimate action, there- 
fore, would almost necessarily be exercised by the 
fluids. 

The fluid invariably present in cases of purulent in- 
fection, and added to the ordinary traumatic fluids 
generating septicaemia, is pus. From the nniuerous 
experiments that have been made by the direct injec- 
tion of pus into the veins, certain facts may be consid- 
ered as proved. 1st. A single injection of fresh pus 
causes a temporary rise of temperature, but no other in- 
convenience. 2d. This same lise of temperature may be 
induced by the separate injection of either pus globules 
or purulent serum. 3d. The injection of purulent 
serum holding inert solid powders in suspension, will 
determine the formation of pulmonary ecchymoses 
and infarct! if the serum be fresh ; of pulmonary ab- 
scesses if it be beginning to decompose; of septicaemic 
symptoms and visceral gangrene if it be entirely 
putrid. 4th. The repeated injection of fresh pus at 
intervals of two or three hours will produce metas- 
tatic abscesses according to Sediflot ; but according to 
Billroth, who repeated these experiments, only a rise 
of temperature sometimes, external suppurations, and 
occasionally pulmonary ecchymoses. 5th. Finally, 
the injection of putrid pus will determine a violent 
septicaemia, with patches of visceral gangrene, and, in a 
concentrated form, is one of the most violent poisons 
known. .012 of the dried residue is sufficient to kill a 
small dog. 

The entrance into the economy of pus or of some cf 
its elements, would seem, therefore, to act in one of 
three ways : 1st. As a medium for the diffusion of 
solid particles, which would block up the capillaries of 



80 



THE MEDICAL RECORD. 



t!ie lungs, and thus form inforcti, acoording to the 
theory of embolism. ThcJC solid pariioles could not, 
however, be tlie pus globules themselves, because, iu 
c'iiiie il conditions, these could never penetrate into the 
blood except in very small «piaiililics, and a single in- 
jection of much larger quantities of fresh pus will not 
produce such cflocts. litl. Tiie pus ma}' bo supposed 
to act by a peculiar alteration of the blood, such* as 
oi'cwrs by repeated injections at short intervals. 3d, 
Finally, it may act as a i)utrid fluid, but endowed with 
toxic properties of peculiar intensity. 

The tlieory of embolism, invoked fof the explanation 
of metastatic visceral absce-ses, has, as every one know.s, 
been snceessfully applied to the pathogeny of cerebral 
and pulmonary apoplexies ; and there is no need in this 
place to enter upon its details. That the ccchymoses 
determined by the injections of fresh purulent serum 
and inert powders, represent the initial lesion of me- 
tastatic abscesses, is rendered probable by the frequent 
clinical coexistence of the two, together with that of all 
the intt'rmediate stages beiwecn them. Thus, in an 
i:itere-;iing case of acute pysemia, laid before the New 
York Patiiological Society by Dr. Janeway, the lungs, 
liver, spleen, kidneys, and, extremely rare circumstance, 
even the heart, are said to be studded with " minute 
white spots surrounded by a red areola," evidently me- 
tastatic abscesses. Tiie first stage of such abscesses was 
represented in the lungs by numerous nodules of pul- 
monary aporilexy ; the last, at the apex of the heart, 
by two small cavities entirely filled with pus. 

But the progress of such infarcti towards suppuration, 
which is the characteristic fact of clinical pytemia, and 
which is so difficult to reproduce in experiments, im- 
plies the addition of some other element to that of em- 
bolism ; for ordinary infarcti do not suppurate, but un- 
dergo the fatty or cheesy degeneration. In pyaemia, 
therefore, eitlier the embolus, or the liquids with which 
it is impregnated, or both, m.ustbe posses>ed of peculiar 
properties, and to them must be due the lobular inflam- 
manon of the lungs, and the suppuration in which it so 
rapidly terminates. This local inflammatory jiroperty 
may be considered identical with the general pyrogenic 
action that these same fluids exercise on the blood, and 
both depend on the accelerated metamorphosis of tissue 
and consequent generation of heat due to rapid chemical 
combinations. 

Difi'used suppurative inflammations are, tlierefore, 
unquestionably the proximate cause of visceral metas- 
\tatic abscesses ; and Ranvier, in his recent paper already 
a'luded to, considers them sufficient explanation, with- 
out any necessity for the intervention of embolism. 
This distinguished microscopist declares that he never 
found the small vessels surrounding the abscesses to be 
obstructed; but on the contrary, during the ascending 
period of the abscess, they were always gorged with 
blcod. These negative facts prove nothing, however, 
against the former existence of capillary embolics, which 
disappeared in the midst of the vascular afflux their 
mechanical and chemico-vital irritation had determined. 
At all events, these inflammations which M. Ranvier 
shows to be nodules of catarrhal pneumonia, with pro- 
liferation of epithelium, are very different from the dif- 
fused patches of congestion or gangrene determined by 
the injection of putrid matters, whether these be puru- 
lent or non-purulent. In the latter case the eflect on 
the general mass of the blood overpowers the local 
effect on special groups of capillaries. The lesions, 
those of septicaemia, resemble those of typhus, while the 
catarrhal pneumonia of pyemia resembles that induced 
by injection of solid powders into the bronchial tubes. 
The peculiar relations of the capillary net-work of the 
lungs to the circulation, net-work which must necessa- 



rily be traversed by any solid particles circulating in the 
blood; the coincidence in pyiKuiin, of such conditions 
as render tlie circulation of such particles highly proba- 
ble; the almost universal localization of pyaeiiiic ab- 
scesses in the lungs, where Billroth found them in 
seventy-nine out of eighty-four cases ; the coexistence 
of all grades of lesions intermediate, with ecchymoses 
and infarcti, and completely formed abscesses; all these 
facts indicate that the first-nameil mode of the action of 
pus — that where it acts as a medium for difl'using solid 
irritative particles — is one of the most characteristic, 
and that w hich chiefly distinguishes it from non-puru- 
lent septic fluids. 

In the second place, the fact that repeated injections 
of pus will produce effects that cannot be determined 
by a single injection, imply that the pus may act by a 
previous special alteration of the blood agam different 
from that of .septicasmia. According to Sodillot, the effect 
of repeated injections of pus is to accumulate its cor- 
puscles in the blood, and thus block up pulmonary ca- 
pillaries by a peculiar kind of embolism. But this 
could not be true in clinical cases, for there the pus is 
not injected directly into the veins, but its elements, if 
they penetrate into the circulation at all, are diffused 
gradually in too small proportions to cause mechanical 
obstruction.* 

Billroth admits a multiplication of the white blood- 
corpuscles, and an increased tendency on their part to 
accumulate in the capillaiies of the lungs, whence the 
metastatic abscesses. He thus explains both the excess 
of white corpuscles noted by Sedillot, and also the pe- 
culiarity of the action of pus, as distinguished from that 
of septic non-purulent fluids. 

Perhaps it is not too hypothetical to connect this 
excess of white corpuscles with the tendency to puru- 
lent efi'usions in the splanchnic serous cavities and in 
the articulations. These do not depend upon inflam- 
mation, for that seems rather to follow than precede 
them ; and thc-y may be reabsorbed with a rapidity un- 
known in ordinary purulent arthritis. 

"When the pus is putrid it acts like putrid fluids, and 
determines not pya3mia, bijt a septicaemia of peculiar 
malignanc}'. The poison generated in pus, therefore, 
seems to be much stronger than that of other fluids. 

Having passed in review the notable differences that 
exist between septicaemia and pya?mia in regard to 
their symptoms, the time and mode of their invasion, 
their anatomical lesions, and their reproduction by ex- 
periment, we are led to inquire whether these differ- 
ences depend upon the operation of different poisons, 
or of the same poison operating in diff'erent conditions. 
The second doctrine is most emphatically affirmed by 
M. Verneuil in tlie recent discussion at the French 
Academy. He declares that pyjemia or purulent infec- 
tion is to be regarded as an accidental complication of 
a general disease, septicaemia, which in a mikl form, at 
least, exists necessarily in the case of every open wound. 
Septicaemia depends upon the absorption of sepsine, 
generated in the traumatic fluids; pyiemia occurs when 
this sepsine impregnates emboli that, carried to the 
lungs, form metastatic abscesses, cf which each becomes 
a new focus of infection. 

The term sepsine, invented by Bergmann and adopted 
bj' Yerneuil, represents the unknown quantity existing 
in purulent or putrid hquids that gives them their pe- 
culiar pyrogenic properties. Great eflbrts have lately 
been made to isolate this hypothetical substance. 
Panum and Hemmer have shown that it exists partly 
in the serum of the pus, partly in the filtered globules. 

* M. Pornariiuay has recently performed some experiments, coiisi« 
dered to prove that such penetration does take place. See Archives 
Generales for December. 



THE MEDICAL RECORD. 



81 



It is not volatile, and cannot be distilled from pus, but 
remains behind in the dry residue. An aqueous extract 
of this residue is toxic, and, moreover, will ditruse 
through animal membranes, and communicate its pro- 
perties to pure water on the other side. Tlii-! diffusi- 
bility is an eminent characteristic of the "sepsine," so 
called ; and in virtue of it Bergmann claims to have iso- 
lated the toxic principle from many others with which 
it was associated, including inorganic matters, albumi- 
nous substances, and leucine. 

Direct experiments with a number of substances, as 
various salts of ammonia, sulphide of carbon, solutions 
of leucine or tyrosine, either produced no effect, or 
symptoms cpiite different from those of septic or puru- 
lent infection. With sulphide of ammonium alone, 
Weber, who employed much stronger doses than Bill- 
roth, obtained a notable rise of temperature and aseptic 
inflammation of the intestinal mucous membrane. 

Until the toxic principle in the two cases shall have 
been isolated its unity cannot be considered proved. 
In the mean time the following facts speak in favor of 
the existence of two poisons analogous to each other, 
but not identical. 

1st. That non-purulent liquids, holding solid particles 
in suspension, do not determine the same lesions as 
purulent serum, that has first been filtered of its glob- 
ules and then associated with inert powders. 

2d. That the train of symptoms which occur after the 
establishment of suppuration, are not merely different in 
degree, but in kind from those which have preceded it. 

;-id. That pus exercises an action apart from that de- 
termined by its putridity. 

4th. When pus is putrid it is a more violent poison 
tiian other putrefying traumatic fluids. Clinically the 
presence of putrefying pus is associated with the mixed 
disease, septico-pyajmia. the most fatal of all surgical 
affections. 

5tb. The conditions of the diffusion of pus have been 
shown to be different from those of primitive septi- 
casmia. 

Independently, however, of the probability of som.e 
special toxic agent in pus, which gives a peculiar char- 
acter to pyaimia, the existence of metastatic abscesses 
introduces new complications by multiplying the foci 
of infection. From each abscess new pyrogenic material 
is continually being thrown into the blood, and when 
the abscess is situated in the lungs, the material that 
has been formed there is probably peculiar, on account 
of the peculiar exposure to air to which it has been 
submitted. 

The dependence of the characteristic march of pyasmia ! 
upon metastatic abscesses, is shown by the insidious 
invasion of its symptoms at this moment of their forma- 
tion, and by its gradual intermittent progress in pro- 
portion to their successive evolution. Hence tlie initial 
chill uft^r the subsidence of traumatic fever; hence the 
increasing violence of the chills as the visceral suppura- 
tions become more numerous ; hence the peculiar dan- 
ger of pulmonary abscesses so much greater than that 
of even pya^mic abscesses formed in external cellular 
tissue. 

On the other hand, it is unquestionable that the vio- 
lence of pyajmia is not invariably in proportion to the 
number of pulmonary abscesses; and that in certain 
cases where the first symptoms have coincided Avith 
external suppurations, the abscesses found in the lunps 
after death are evidently of recent formation. I have 
seen several such cases, in which, even though the final 
catastrophe be attributed to the pulmonary complica- 
tion, yet it is imquestionable that pyaemia must have 
been prior to it. In these cases it is impossible to avoid 
belief in the direct action upon the blood of the ele- 



ments of pus derived from the surface of the original 
wound. 

The prophylaxis of septicfemia is more easily attained 
than that of pyaemia, because the conditions upon which 
septic poisoning depends are less peculiar than those 
of pyaemia. There is no special anatomical condition of 
tlie wound, such as exists when bony tissues are in- 
volved. The system is capable of tolerating the ab- 
sorption of a certain amount of septic material, and 
Avhen, from the extent of the traumatism, there is an 
excess of dead tissue, this may be removed by surgical 
interference. The great indications in the prophylaxis 
of septicaemia are 1st, to prevent the devitalization of 
new tissues ; 2d, to prevent the exposure of tissues 
thus devitalized to the action of infusoria, or animal 
germs, the agents of putrefaction. 

The first indication is pre-eminently fulfilled by 
purification of the air which the patient is compelled to 
breathe. This is effectual, not on account of any 
direct action upon the wound, but by maintaining the 
nutritive powers of the blood and its consequent action 
upon tissues whose vitality is threatened. So long as 
this vitality is maintained, the development of micro- 
zymes is to be little dreaded. 

The second condition is only completely fulfilled 
when air is completely excluded from the wound, and 
with it, on the one hand atmospheric germs, on the 
otherthe oxygen necessary to the development of animal 
microzymes. Air is nearly excluded when a wound 
is enveloped in an atmosphere of carbolic acid, and to 
such exclusion, must be largely attributed the favorable 
result of such treatment. Occlusion, either by this so- 
called " antiseptic " or by mechanical means, may pre- 
vent the decomposition of traumatic fluids ; but when 
this has once set in, nothing will arrests it, not even the 
destruction of the germs which may have been its 
cause, as we have seen, these die of themselves in the 
putrefying fluids whose putrefaction they have deter- 
mined. Hence a treatment directed to their destruc- 
tion would be worse than superfluous, if it led to neg- 
lect of the great indication in the prophylaxis of this 
stage, removal of the traumatic fluids from beyond the 
reach of absorbents. 

The greater facility with which this removal may be 
effected in the case of wounds of soft tissues explains 
their greater immunity from danger, and the for greater 
success of carbolic acid in their treatment. The septicaj- 
mia that may occur in the course of such wounds, de- 
pends upon the absorption of non-purulent decompos- 
ing fluids, and its intensity is in proi)ortion to their 
mass. When the fluids .-dready formed have been care- 
fully washed away, the use of carbolic acid, that 
will not, by the ordinarj' methods, ^»-ei'e?i< decomposi- 
tion, nevertheless restrain it, and hence reduce septicae- 
raic accidents to a degree of intensity bearable by the 
economy. It is in these cases that the efiect of good 
atmo?pheric hygiene is so apparent, by preventing the 
devitalization of new tissues. The most dangerous de- 
grees of septicaemia may be averted, and its worst form, 
hospital gangrene, be entirely banished from hospital 
waids. 

But pyaemia is connected with much more comphca- 
tcd conditions, many of Avhich are entirely beyond the 
reach of carbolic acid. It depends on the presence of 
a fluid that, once secreted, decomposes with peculiar 
facility, seems to generate a poison of peculiar intensity, 
and expose the products of its decomposition to ab- 
sorption at a moment that the power of absorption is 
at its maximum. It has been shown to act, not mere- 
ly in virtue of such decomposition, like all putrid fluids, 
but by a special effect on the blood, and by a special 
connection with the thrombi blocking up the veins 



83 



THE MEDICAL RECORD. 



surroiimliiig the wound. Whi'c the poison of sep- 
ticaemia is jjiiiieipally absorbed by tlie lymphatics, 
that of pyicmia passes almost exclusively by the veins, 
cither those in the bones, or those newly developed in 
the pranulalions of the wound. 

Tiiis poison is therefore contained in inaccessible 
canals, and carbolic acid lias as little effect upon it as it 
would upon an aljscess in whose cavity it had been in- 
jected and shut up to mix with its contents. A compa- 
ratively minute proportion of purulent poison is capa- 
ble of inllieting all tlie injury possible, so that great di- 
minution of the ma5s of toxic material has very much 
less elTect on the development of pyiemia than on that 
of septicjcmia. The control must be complete, or it is 
useless, and it nmst be exerc'sed not merely" in the 
general hygienic conditions to which the patient is 
submitted, but still more, over the local conditions pecu- 
liar to the anatomical nature of his wounds. 

From this i)redominanee of local conditions, pj'os- 
mia is, as might be expected, no exclusively hospital 
disea'^e. IJillroth asserts that it is as common in 
private practice as in hospitals, only when a death 
occurs that cannot be explained by hospital miasms, it 
is attributed to gastritis, or other accidental complica- 
tion. Mr. Callender, in the fifth volume of St. Bar- 
tholomew's Hospital Reports, shows tiiat although the 
mortality of city patients operated on in city hospitals 
was higher than that of the country, yet the mortality 
of country patients was the same, whether they were 
in large city hospitals, in small country hospitals, or 
even in average country practice. 

It follows that absolute exclusion of air from the 
wound is much more important in the prophylaxis 
of pyaemia than of septicaemia. The partial occlusion 
effected by incrustation with carbolic acid, is often 
sufficient for wounds of soft tissues. But for wounds 
involving osseous tissues, the apparatus employed by 
M. Maisonneuve at the Hotel-Dieu is much better 
adapted. Most American surgeons visiting Pai'is have 
had an opportunity of observing this method of treat- 
ment, but 1 do not know whether it has been intro- 
duced into this country. The moment that a limb is 
amputated, the stump is surrounded by a conical gutta- 
percha cap, whose rim fits air-tight to the skin. From 
the apex of this cap passes an India-rubber tube that 
connects with an aspirating pump. B}' means of the 
pump the liquids from the wound may be drawn off, 
and discharged by a second tube into a receiver. Dur- 
ing the intervals, the elastic walls of the cap and 
tube coming from the wound, fall together so that no 
air is in contact with the suppurating surface. To 
dress the wound, the tube is detached from the pump, 
and connected with the tube of a bulb-syringe, in 
whose continuity is inserted a short piece of glass tub- 
ing, so that the operator may watch the stream of fluid 
he injects upon the stump, and be sure that no bubbles 
of air pass over. The detersive licpiids employed are 
either tincture of arnica or a solution of carbolic acid. 
These, injected in a continuous stream on the stump, 
are allowed to flow off by a secondary tube, connected 
with that of the bulb-syringe. In this way the wound 
is dressed daily, without the least exposure to the air. 
The apparatus may also be used in cases of accidental 
traumatism, as compound fracture ; but here it may be 
less efficacious, when the dead tissues have already 
been for some time exposed to the air. 

As fir as my own observation extended, this appa- 
ratus yielded excellent results, and the principle upon 
which it is based seems certainl}^ most rational. I am 
unable to tell why it is not adopted in other surgical 
wards than those of M. Maisonneuve.* 



* I found. aftPT writing the above, an account of Maisonneuve's appa- 
ratus in the fifth volume of the PractUionei\ 



FORCIBLE MANUAL DELIVERY IN PU- 
ERPERAL CONVULSIONS. 

By JOHN M. JULIAN, M.D , 



The small number of reported ca,sesof manual version 
in puerperal convulsions prompts me to offer a contri- 
bution to the subject, with a view of calling the atten- 
tion of the profession to an efficient means of saving 
the life of mother and child, which means have not 
received the attention which, in my opinion, they de- 
serve. This is more particularly the case since anes- 
thetics have been found to be so uscfid in the manage- 
ment of the various complications of labor. 

I was fu-st led to favor forcible manual delivery by 
hearing of the death in convulsions of a primipara un- 
delivered, aged 19, eight months advanced, whom I 
had visited incidentally. In that, case I learned that 
thij persistent administration of chloroform had uo 
result whatsoever. 

After having seen this ca;e, I determined to try, in a 
similar case, the effect of Ibrciblc delivery. An oppor- 
tunity for so doing soon presented itself On the 
9th of June, 18C4, I was called to see Mary M., set. 
21. She was six and a half months pregnant, had been 
eight hours in convulsions, was ura;mic, had stertorous 
breathing, pulse rapid and feeble, pupils insensible to 
light, and the os barely admitting the end of the index. 
With much less difficulty than I had previously antici- 
pated, my hand was introduced into the vagina, next 
the index, and subsequently, one by one, all the other 
fingers were forced through the os ; next the hand was 
passed in the uterus; one knee was hooked and brought 
down ; find the delivery of a male child accomplished, 
in the course of about tw-enty minutes. The convul- 
sions did not return after delivery ; but she never 
rallied, and expired the next day. 

Case II. Reached Mrs. S.'s bedside September 8th, 
1S64 (town of Guttenberg), a;t. 3G, primipara, whowa.s 
in labor, had frightful oedema of body, was insensible, 
and had stertorous breathing. Had been fifteen hours 
in convulsions ; os admitting the end of the index finger. 
I administered chloroform at once, and thereby con- 
trolled convulsions, so as to enable me to deliver a pair 
of male twins, the first, by version, being still-born ; 
the other, by pedal extraction ; alive. There was one 
slight convulsion three hours after delivery. Con- 
sciousness returned the next morning, the albumen 
disa[ipeared at the end of the sixth day, and mother and 
child made a rapid recovery. 

Case IlL Saw Mrs. S., set. 23, in consultation, 
Nov. 21, 1SG5 ; primipara. with the usual uraemic symp- 
toms ; had been fourteen and one-half hours in con- 
vulsions ; insensible and stertorous since first attacked ; 
OS undilated, no apparent symptoms of labor present ; 
digital and manual dilatation and version performed in 
less than thiity minutes, (with sanction of her medical 
attendants), in the usual way, under chloroform. One 
slight convulsion three hours after delivery ; she re- 
mained insensible and afterwards delirious for over 
fortj'-eight hours, from which she recovered; but 
succumbed, one month from date of delivery, to an 
attack of pleuro-pneumonia. Child ever after subject to 
occasional epileptic convulsion, who died two years 
after, of cerebral disease. 

Case IV. Saw, in consultation, on the first of March, 
1866, at 11 A.M., Mrs M. Stage of pregnane}', eight 
and one-half months, primipara, urine two-thirds 
albuminous, countenance antemic, fixed pain in fore- 
head, nausea, pulse rapid and feeble. Counselled in- 
duction of labor. At 5 p.m. a convulsion occurred. At 



THE MEDICAL RECORD. 



83 



9^ P.M., with the concurrence of her medical attendant, 
she being fully conscious and about the room at the 
time, OS closed, was placed in the recumbent posture, 
and fully aniusthetized. I inserted my hand as before 
(encountering' this time a little more rigidity than usual), 
and delivered twins — the first child by version. Both 
children lived. The mother made a rapid and uninter- 
rupted recovery, tlic operation occupying about half 
an hour's time. 

Case V. Saw, on August 4, same year, a next-door 
neighbor to !Mrs. M., Mrs. W. Stage of pregnancy 
said to be eight months. Had been about ten hours 
in convulsions ; primipara, urtemic, deep stertor, pulse 
rapid and feeble, circulation apparently ceasing. Had 
been previously to my coming ineffectually anjesthetized 
during several hours ; os undilated. I proceeded at once 
to deliver in the usual way, which Avas soon accom- 
plished, this time without anaesthesia. The convul- 
sions ceased after delivery, but she expired the next 
day. 

Case VI. Mrs. J., a?t. 22, secundipara, who, during her 
previous pregnancy (sixteen months from date), had 
suffered from uraiinic convulsions, ending, five or six 
weeks after their occurrence, by the spontaneous expul- 
sion of a decomposed foetus; whole growth appeared to 
be of about five months. I was requested to see her 
on the 5th of March, 1869, at 4 a.m.; said to be in her 
seventh month ; face and lower extremities oedematous ; 
headache, nausea, pulse about 54 ; had had two con- 
vulsions previous to my coming; medical attendant 
gone home 12^ p.m. ; return of convulsions and vomiting, 
pulse 40 ; insensible, os closed, no symptom of labor. 
I at once proceeded to perform version under chloro- 
form, and in the usual and above-described way, which 
was accomplished in about twenty minutes ; child a 
male one, non-viable. The convulsions never returned, 
consciousness became gradually restored, and she 
made a rapid recovery. On the 6th of June, 1871, she 
was again spontaneously delivered at eight months of 
another male child, but this time without; convulsions ; 
child died on the twelfth day, of epileptic convulsions; 
albumen Avas again detected in Mrs. J.'s urine. 

In conclusion, I will state that my object in publish- 
ing the above has been to induce others to give the re- 
sult of their experience in this matter, and help to 
establish, by a sufficient number of precedents, the 
propriety or impropriety of the operation. Inas- 
much as a great number of obstetrical authorities look 
upon the measure as a most desirable one if it can be 
accomplished without injury or detriment to the pa- 
tient, I think that on this point the general result of 
my cases ought to have a tendency to dispose of this 
objection, and demonstrate that the operation can 
a priori be performed with tolerable safety and celer- 
it}'. They also suggest the belief that, under full an- 
aesthesia, the question of non-dilatability of the os has 
not been as yet properly or sufficiently looked into ; 
and that, at least in special cise^, this operation 
ought to take precedence over the safer but more tardy 
rule of induction. 

Theref ire, I feel most sanguine in the belief, that 
should this mode of procedure be more generally fol- 
lowed, in like emergency, the mortality tables of puer- 
peral convulsions would become notablv improved, 
and the lives of fewer women and children sac- 
rificed. 

In corroboration of the preceding remarks, I beg to 
observe that, in a very extensive search made into the 
. literature of the subject on manual dilatation in puer- 
P-^ral eclampsia, I have found but five cases, which, 
however, fuily substantiate m}'' views : one of these 
will be found by Nocggerath and Jacobi, another by Dr. '' 



Paget, one by Dr. J. H. Ross, and two by Dr. Holland, 
copied from the Lancet, and found in Braithwaite's Re- 
trospect, Vol. Ixiv., the results of all of which were 
successful, and one equally successful in Milne. 

I will further observe that the large sanguineous de- 
pletion deemed indispensable, and so firmly relied on, 
is fiilling into disfavor. In the Guy's Hospital Re- 
ports for 1871 will be found a scries of cases, by Dr. 
Phihps, in which bleeding was not resorted to, and 
chloroform mainly relied upon for the control of con- 
vulsions ; a practice which has likewise been followed, 
in the latter part of his life, by our late distinguished 
fellow-to\vn=man. Prof Geo. T. Elliot. 

273 West 21st st., New York. 



procuress of iHetJical Science. 



The Blood in Syphilis. — Dr. Lostofer's alleged dis- 
covery of bodies peculiar to syphilitic blood, has led 
to considerable discussion in Vienna, the most promi- 
nent of his opponents being Dr. Wedl, who claims that 
they are only oily particles obtained from the sebaceous 
follicles in the operation of puncturing the skin. The 
bodies under question are described as having a diame- 
ter ranging from jii^nr to T^riuir of an inch, their con- 
tour being sharply defined, and light being strongly re- 
fracted by them. They are said to have a greenish- 
blue tinge. With regard to the vacuoles with which 
these corpuscles are said to become surrounded, Dr. 
Wedl believed them to be the result of a destructive 
process, being induced by the development of water and 
of carbonate of ammonia during decomposition of the 
blood, the same phenomenon being observable when 
an emulsion of human fat is heated with a solution 
of potash. The reason why Dr. Lostofer had seen 
these corpuscles only in blood after four or five days, 
and not in fresh blood, was that they were covered by 
the blood corpuscles. 

Professor Strieker said he had placed a hundred 
specimens before Dr. Lostofer who had diagnosticated 
correctly those taken from syphilitic patients, with the 
exception of twenty doubtful eases. He did not 
venture to assert that they were either germs or 
fungi. 

Dr. Neumann said that nearly four years ago Hallier 
described the structures found in the blood in infectious 
diseases, including syphilis; he said these gave rise to 
syphilis, and their most minute elements penetrated 
the blood corpuscles and rendered them diseased. The^e 
corpuscles multiplied by division, assuming the charac- 
ters o{ coniothecium. Hallier had found them in syphi- 
litic paronychia, condylomata, and in other manifesta- 
tions of syphilis. Oklotsch had also found traces of 
them in the skin as well as in the blood. The result 
of experiments which he had made Avith specimens of 
blood from persons presenting various forms of syphi- 
lis Avas, that bacteria Avere developed in the blood-cor- 
puscles of the infected blood which differed in no re- 
spects from those developed under similar circumstances 
in the blood from other contagious diseases ; even after so 
long a period as tive months these organisms multiplied 
in their OAvn forms, and. in spite of the addition of the 
A'arious organic and inorganic substances, no fungi 
Avere found. Since Dr. Lostofer had announced his dis- 
covery, he (Dr. Keumann) had made fresh investiga- 
tions, and had found that the corpuscles might be de- 
A'eloped in various numbers and sizes in different kinds 
of blood. He had found them in the blood of small-pox, 
eczema, etc.; and therefoie they could not be regarded 
as a specific indication of syphilis. 



84 



. THE MEDICAL RECORD. 



The discussion tcnnina'cd with the aiipuintiiioiit of 
a comiiiitti'C to invcsiij,'ale the suhjict, c'oii8istiii<,' of 
Dr.". K(>kitnii*i<y, Hnicke, Billrotli, keiclifit, Karsicn, 
KI<>1>, liausch, ;ur1 Aiispitz. Dr. Kraus, cdiior of the 
Alg. Wiener Med. Zeil., m of the opinion thai Dr .Striek- 
er, IIol>ra, and others have been deci-ivid, and have 
acted nio^t unwi.-ely in furmin;.' their opinions so rapid- 
ly. Sk(;da i^ecnis also to have been very precipitate. 

Protr.\ctkd Gk.«tation with PuEnrEnAi, Convi'l- 
Pioxs. — K. P. Bernanl}', Philailelpiiia {I'liVa. Med. 
Times), relates a case of protracted <::estjitiun, in aprinii- 
para, in which the child was carried, he believes, three 
liundrcd and forty-four days. During tliirty-three 
convulsions, extending over a space of eight hours, 
eleven .><crup!es (220 grains) wore given, wliiih only 
seemed to cpiiet her. There was no deep sleep, the 
)iaiient being easily wakened. Tliis is interesting as 
showing how mucli hydrate of chloral can be given in 
convulsions without any bad eflect. 

The eliild was enormous, weighing fifteen pounds, 
and, when drcssel. appeared as if it were three months 
old instead of a few hours. The proportions of the 
head were as follows: circumference, 15 inches; occipito- 
mental diameter, 8 inches; fronto-mental, 4+ inches; 
occipito-frontal, GJ inches; length of the body, 2G| 
inches; weight of the body, 15 lbs. 

Uterine Anomaly. — Dr. Hening, at a late session 
of the Leipsic Obstetrical Society {/own. Gynceco- 
logical Sue), reported in brief a case of uterine 
anomaly in a girl fourteen years old, in which, in- 
stead of the uterus, there was a shallow pocket two 
centimetres deep. 

Microscopical Exa.mination of the Sputi'm. — Dr. A. 
P. Dutcher, Cleveland, Ohio (Cinn. Med. A'eif.s), adds 
his testimony as to the value of a microscopical exami- 
nation of the sputum as a means of diagnosis in chest 
diseases. Dr. Huglies Bennett concurs w'ith Dr. T. 
Thompson in recommending it as a very useful means 
of diagnosis in all doubtful cases of phthisis. Dr. An- 
drew Clark, of London, regards the examination of the 
sputum as the only certain means of detecting the dis- 
integration of the lungs and the increase of the disease. 

Chronic Cystitis in the Female, and Treatment. — 
In an interesting paper on this subject by Tliomas Ad- 
dis Emmet, M.D., Surg, to K Y. State Woman's Hos- 
pital (Am. Practitioner), describing a mode of treatment 
original with him, with cases, allusion is made to the 
paper on " Tlrcthrocele, Catarih, and Ulceration of the 
Bladder in Females," which was published in the X. Y. 
Journal of Obstetrics, Feb., 1S71. Dr. Bozeman is 
quoted as stating that the operation for the relief of 
cystitis by an artificial opening was performed by him 
January, 1801, and that ''to Prof. Wiliard Parker is 
due'the suggestion of opening the male bladder for the 
relief of catarrh, and this encouraged me to extend the 
practice to the female bladder," and that "Dr. Emmet 
and other American surgeons have since adopted the 
practice in case of vesical catarrh in the female, and I 
doubt not with equal success," and that the "' delay in 
the report of my case of ulceratioti was due to the sus- 
pension of all medical journals in the South during the 
war." 

Dr. Emmet says that this statement is unfortunately 
calculated to give the impression that the American sur- 
geons who have practised this mode of treatment since 
1861 were indebted to Dr. Bozeman. This is errone- 
ous, as until his paper was r-ad at the meeting of the 
New York State Medical Society, Feb. 7th, 1871, he 
(Dr. B.) had not given the profession an opportunity 
of knowing that he had ever operated. 



Dr. Emmet's claims to priority extend back to the 
year 1858, when, by the advice of Dr. Sims, after the 
removal of a calculus from tlic V^ladder by an artificial 
opening made in the vesico-vaginal septum, the aper- 
ture was left open for restoring the organ to a healthy 
state. In 18G1, for the relief of a case of chronic cys- 
titi.s, an artificial vesico-vaginal fistula was made by 
him, with the view of giving rest to the organ bv the 
free esca|ie of urine. 

The history of a case, upon which he had just operated 
by making an incision transverse to the axis of the vagina, 
was read at a meeting of the N. Y. Obstetrical Society 
in Dec, 1870. Prof. James P. White, of BiifTalo, an 
invited guest on that evening, reminded the author that 
he a.ssisted at the operation in ISGl, and, by a curious 
coincidence, was present at the final closure. 

Detection of Hydrochloric Acid in Cases of Sus- 
pected Poisoning. — J. Bonis (Journ. nf Applied C'liem- 
istri/) filters the liquid through linen and paper 
previously moistened with acetic acid, and introduces a 
few crystals of chlorate of potash and some gold foil. 
The whole is then heated over a water-bath an hour or 
more, and the presence of the free acid determined 
from the quantity of gold that goes into solution. 
Chloride of tin at once betrays the faintest trace of any 
gold that may have been dissolved. If the liquids to 
be tested are very dilute it is advisable to concentrate 
by evaporation. The author was able to detect in this 
way the presence of a few centigrammes of hydro- 
chloric acid in a large quantity of liquid. He made 
comparative examinations to prove that chlorides of 
sodium, potassium and the like did not produce similar 
reactions. 

Antidote to Carbolic Acid. — A strong solution of 
saccharate of lime, it is asserted, is a reliable antidote 
against the poison of the carbolic acid when by acci- 
dent taken internally. 

A New Method of Plugging the Posterior Nares. 
— Henry Manfred, M.D., Cincinnati, Ohio, late Surgeon 
22d Ky. Infantr}' (Cin. Lancet and Observe)-), afier try- 
ing all the ordinary remedies for epistaxis (the hospital 
being without a plugging instrument), in the case of a 
soldier who had suffered for four da3's and nights with- 
out cessation, a pair of leather laces were successfully 
used in the emergencj'. The leather thong was care- 
fully pushed along the floor of the right anterior nares 
until the end protruded through the posterior opening, 
trailing upon the epiglottis and producing cough; this 
loose end Avas secured by the forceps and drawn out 
through the mouth, and after attaching thereto pledgets 
of lint saturated with astringents, it was drawn back 
again until the right posterior nares was effectually 
plugged, and tied in front. The same process was re- 
peated with the left posterior nares, and in half an hour 
the hemorrhage was stopped. He fully succeeded in 
plugging the right and left posterior nares, by such a 
simple though efi'ective agent. From its simplicity, ef- 
ectiveness, and practicability, it is to be recommended 
to those who may be similail}' situated. 

The Eye in Brigiit's Disease. — With regard to the 
frequency of changes in the eye in Bright's disease, Dr. 
Wadsworth, of Boston {Boston }[ed. and Surg. Journal), 
stated that he had for some time past examined every 
case that had been admitted into the City Ho.-pital, and 
had found that in about 25 per cent, trouble in the eye 
existed. Dr. Fifield said that the strange part of thtse 
cases was the great and sudden variation in the state 
of vision. In some cases vision would be very much af- 
fected for a few days, and then would become almost 
normal 



THE MEDICAL RECORD. 



85 



The Medical Record: 

A SEMI-MONTHLY JOURNAL OF MEDICINE 
AND SURGERY. 

GEORGE F. SHRADY, A.M., M.D., Editor. 



Pxibliiihed on the 1st caul \^th of each Month hy 
WM. W'OOD & €0., 27 Great Jones Street, N. Y. 



ISTew York, .A^pril 1, ISTS. 



MEDICAL COLLEGE COMMENCEMENTS. 

The College Commencements are now over, and medi- 
cal educational circles have a temporary rest. The 
students have received their diplomas, the addresses 
by professors and valedictoiians have all been duly 
delivered, the various orchestras have done their part, 
and now the medical sensation-hunters are left to their 
sober reflections. When we compare the present 
graduation exercises with what they were twenty 
years ago, we are forced to acknowledge that great 
changes have been made in the manner of conducting 
them. When we were fortunate enough to receive our 
medical diploma from the faculty of one of the three 
medical schools of this city, we were treated to the 
usual long and heavy address from one of the professors, 
and the only element in the whole proceeding which 
made it more than one of the dryest and most tedious 
lectures of the term was the exhilarating presence of a 
few of our female friends, who from motives of mere 
pity consented to worry through the hour, and assure 
us afterwards, in a purely feminine sense however, 
that they were gratified. Every graduate enjoyed these 
occasions because it was to be the last straw that 
could in the way of a lecture be pliced upon the back 
of liis memory. No one looked for arjy thing more, save 
perhaps the questionable propriety of promenading 
his friends through the college museum to guess at 
the character of half of the specimens so conspicuously 
covered. It was considered " derogatory to the dignity 
of the profession " to court anything in the shape of the 
ordinary means of amusement on such occasions, and a 
band of music was thought to be as much out of place 
as it Avould have been in an old -timed Puritan prayer- 
meeting. But we have lived to see all this changed, 
and we can say, that so far as the introduction of good 
music and the other accessories of an enjo3'able enter- 
tainment are concerned, the innovation has been a very 



commendable one. There are, however, changes to be 
made for the better in the accessories, and by these we 
refer to the addresses. Occasionally we are treated to 
first class cflbrts in that direction, but in the main, 
when left to the faculty, they are to the Inst degree 
commonplace and tedious : commonphice. if the aim is 
to interest a promiscuous audience; and tedious, if 
treating upon a i:>urely scientific subject. Every one 
who takes the trouble to go to a College Commence- 
ment is willing to admit that medicine is a noble pro- 
fession, in fact the noblest of all professions, that, the 
graduating class have shown a lemarkable proficiency 
in their studies to gain a d'ploma from a faculty so 
jealous of the interests of medical education, and that, 
all told, the said college must be the best in the countiy. 
Every one is willing to admit, for the sake of the argu- 
ment, that it is up-hill work to succeed in the practice 
of medicine — that even those brilliant young men who 
with demure looks and bowed heads are receiving the 
professorial blessing are not exempt from the applica- 
tion of the saying that " there is no royal road to 
knowledge;" all this is a very old story, and if it is to 
be told, after the stereotyped flishion, witli the worn- 
out anecdotes from Smiles' Self-Help, and Jeaffreson's 
Bijoh ahout Doctors J becomes almost unbearable. Now, 
why can we not keep up the new fashion of inviting 
some practised and entertaining speaker to interest our 
commencement audiences ? This has been tried with 
good effect on more than one occasion, and we see no 
i-ea.-on why this practice cannot be kept up. 

The addresses of the valedictorians are well enough 
in their way. They give a variety to the entertain- 
ment, and, in return, the audience is generally good-na- 
tured enough to submit to the habitual sophomorical 
display of oratory. The only improvement that could 
be suggested in these addresses, would be to have 
them as brief as would be consistent with the gratifi- 
cation of the speaker. 

I3ut there is one aspect of this subject which in this 
connection deserves a passing reference. The changes 
that have been wrought in our college exercises have 
had the eflcct, at least, of drawing large audiences, 
as large perhaps as usually attend the literary schools 
on such occasions. This has an unquestionably good 
influence upon the general pubhc in impressing 
them with the fact that there is an enthusiasm in 
the cause of medical education, and that our medi- 
cal institutions are progressive and prospering. Each 
institution has the opportunity of maintaining a gen- 
erous rivalry in this respect, and if limited by the 
rules of ordinary propriety, we have reason to 
expect that the jealously-guarded dignity of the pro- 
fession Avill not suffer. But that there is danger 
of carrying the competition a little too far is pain- 
fully manifest in more than the mere commencement 
exercises. The colleges, stimulated by their respective 
successes, are promising to become the centres of un- 
compromising cliques. Already with some fanatical in- 



86 



THE MEDICAL RECORD. 



diviJunls tlie fi't'ling of competilion is fostered to that 
extent tliat hardly the actual courtesies arc alloweil be- 
tweon the parties of the diflerent schools. In the in- 
teresLs of the general profession of this city we arc sor- 
ry to entertain tlie suspicion of inij)eiiding discords. 
We rejoice in the pro.><perity of the schools at large; 
we should be glad to see the spirit of legitimate emu- 
lation carried to the extent of raising the standard of 
requirement'? still more, but beyond this we do not ex- 
pect to go. We claim that each school has the privi- 
lege of rejoicing over its successes, but neither must 
allow it*; ambition to get the better of its judg- 
ment. Not committed to the interests of any school, 
and alone concerned in their collective prosperity, we 
maintain that the rivalry should be just, honest, and 
courteous. That it is not so, and that there is on 
that account great danger of fostering cliquism, we 
shall on some future occasion take the opportunity of 
proving. 



A.MEnicAX Mkdical Association. 

We learn that great efforts are being made by the phy- 
sicians of Philadelphia to receive the American Medical 
Association with dignity and to entertain them court- 
eously. As soon as the entire programme shall have 
been decided upon, we Avill be furnished with the 
details of the arrangements, and can then announce to 
our readers the character of the scientific and social 
entertainments which will be tendered to them. We 
understand that New York will be ably represented 
in the programme. 



Hcuicius anti lloticeg of l3ooK0. 



A TuEATisE OX Human Piitsiology, Designed for 
THE Use of Students and Practitioners op Medi- 
cine. By John C. Dai.ton, M.D., Professor of Physi- 
ology and Hygiene in the Collec^e of Physicians and 
Surgeons, etc., etc. Fifth edition. Philadelphia: 
Henry C. Lea, 1871. pp. 728. 

Tnis well-known book comes to us again with an in- 
crea_se in size of twentj^-three pages over the edition of 
18G7, which does not, however, represent quite all of 
the new matter, as some of tlie contents of former edi- 
tions has been left, out. The most important changes 
have been made in the chapters on the formation of 
sugar in the liver, coagulation of the blood, the arterial I 
circulation, the excretion of urea, and terminations of 
the nerves. The most valuable of the several wood- ' 
cuts introduced for the first time into this edition are I 
in this latter section. j 

The author states that, recognizing the recent acti- 
vity in the advance of all the natui'al sciences, he has j 
carefully revised the entire work. We have looked 
through its pa^es to see how far this prefatory announce- 
ment is justified by the changes and additions made, 
and whether "the book in its present form" is, as he 
has aimed to render it, "a foithful exponent of the actual 
condiiion of [diysiological science." 

In the section on proximate principles, the introduc- 
tion of Fehling's test for sugar was a needed addition. 

In his estimate of the amounts of fibrin and albumen 



contained in the blood, the author is not consistent. 
Under tiie head of proximate principles in general, he 
says, " It is to be kept constantly in view, in the exami- 
nation of an animal tissue orlluid, that tlu; object of the 
operation is simply tite separation of its ini/rrdicnts from 
each othn; and not their decomposition or idlimate 
analysis. . . Thus, tlie fibrin of the blood can be sep- 
arated only by allowing it to coagulate; and once co- 
agulated, it is permanently altered, and can no longer 
present its original characters of fluidity, etc., as it ex- 
isted beforehand in the blood. In such instances as 
this, wo can only make allowance for an unavoidable 
difficulty, and be careful that the substance Ruffers no 
further alteration." Yet in his estimates ho follows 
the "dry process," and gives the amount of fibrin as 2 
or o parts per thousand, and that of albumen as about 
75 parts j)L'r thousand. The process, of which he makes 
no mention, in which they are separated simply by co- 
agulation, gives about three times as much librin, and 
more than four times as much albumen. 

No essential changes have been made in the section 
devoted to the subject of digestion, and we take the 
liberty of asking atti-ntion to one or two points. With 
regard to the action of saliva in converting starch 
into dextrin and glucose, the author continues to 
maintain the views advocated in the early editions of 
his work, although the fallacy of the experiments upon 
which some of his statements were based was pointed 
out several years since. The action of saliva ni)on the 
food is, he says, simply mechanical ; and although, in 
experiments made with human saliva upon boiled starch, 
the mixture has sometimes shown the presence of glu- 
cose at the end of half a minute, yet this property of 
the saliva is, he thinks, rather an incidental than an es- 
sential one, the food remaining for too brief a period 
in the mouth for the transformativm to take place in 
any great degree, and the process being at once arrested 
by the action of the gastric juice on the anival of the 
food in the stomach. Two important facts aie lost 
sight of in the experiments cited in support of these 
views: first, in carnivora (dogs having been the animals 
operated on) the saliva has but a very feeble action on 
starchy food ; second, some of the principle? contained 
in the gastric juice have the property of interfering with 
tests for glucose. Experiments reported by Longet 
eleven years ago seem to prove pretty conclusively the 
power of saliva to produce this change, in the human 
subject, during stomach digestion. 

Dr. Dalton diflers from most modern writers in his 
description of the tubular glands of the stomach, and 
also in his opinion that all the gastric tubules in the 
various parts of the stomach combine to produce the 
digestive tluid. We think there are few physiologists 
wlao do not consider that the fluid which is most active 
in stomach digestion is secreted by tubules containing 
glandular or spheroidal epithelium, situated most nu- 
merously towards the cardiac extremity of the organ;, 
the tubules met with in greatest frequency at the py- 
loric extremity being lined with columnar epithelium^ 
and secreting mucus chiefly. 

There is a subject of some interest connected witl 
the function of digestion which we would have beeni 
pleased to see at least nientioned, viz., the ability of the] 
large intestine to digest and absorb sufficient nourish- 
ment, in some instances, to maintain life. 

We are not a little surprised at the views expressed] 
with regard to the course taken by the oleaginous] 
principles of the food in reaching the circulation.' 
"The absorption of the digested fluids is accomplished | 
mainly by the blood-ve?seis. . . . The fatty matters of] 
the food," he says, after speaking of albuminoids, 
etc., " are also taken up by the blood-ves?els and pass in 



THE MEDICAL EECORD. 



87 



this way into tlie circulation. . . . The oleaginous ma- 
teiials, thus prepared, are absorbed by the blood-vessels 
of the intestine. . . . The oily matter then pnsses on- 
wards, penetrating deeper and deeper into the sub- 
stance of the villus, until it is at last received by the 
capillary vessels in its interior." The only reference 
made in this connection to the function of the lymphat- 
ics, is this, something over two pages having been 
devotL^d to explaining the modus operandi of the passage 
of, fat into the portal system : " The absorption of fatty 
matter is also accomplished by another set of capillary 
vessels of the intestine, namely, the ' lacteals.' " We 
are atalossto know'on what grounds Professor Dalton 
attributes »the function of absorbing tlie greater part 
of the chyle to the blood-vessels. We are aware that 
in birds this is the case ; but in the human subject, we 
had thought it pretty definitely settled by post-mortem 
appearances, by the effects of disease of the mesenteric 
glands in producing emaciation from obstruction, of the 
passage of chyle, and by experiments upon animals 
approaching nearest to man in the arrangement of the 
digestive apparatus — that, although some of the fatty 
matters may be absorbed by the blood-vessels, yet, far 
the greatest amount enters the circulaiion through the 
lymphatic ."iystem. We question very much if the 
author has, in this regard, made his book " a faithful ex- 
ponent of the actual condition of physiological science." 

Speaking of the modes of origin of the lymphatics he 
says they "are to be found everywhere in the integu- 
ments of the head, the parietes of the trunk, the upper 
and lower extremities, and in the muscular tissues and 
mucous membranes throughout the body," omitting two 
of the most important tissues, viz.. the connective tissues 
and the serous membranes, and therefore any mention 
of their frequent origin in lacunar spaces between organs. 
Indeed, by many histologists it is now considered as 
settled that the serous sacs are integral parts of the lym- 
phatic system. 

In speaking of the function of the bile, the author, 
although at the outset his words would lead the stu- 
dent to infer that this fluid contains excrementitious as 
well as recrementitious principles, makes no mention 
of the excrementitious principles. After giving some 
of the reasons why we might, suppose the fluid to be 
excrementitious, he proceeds to show that the death of 
an animal in which a biliary fistula has been success- 
fully established is owing to the fact that the principles 
of the bile are not brought in contact with the se- 
cretions of the intestinal canal, and with the intestinal 
walls; and lie goes on to state that the bile " is a se- 
cieiion which has not yet accomplished its function 
when it is discharged from (he liver and poured into 
the intestine," and that all of the biliary ingredients are 
absorbed, and are not to be discovered in the fseces. 
Not a v/ord is said of cholesterin, and the student will 
probably end the chapter with the idea that his first 
impression, that the liver had an excretory function, 
was a mistake. 

A considerable addition has been made to the chap- 
ter on the formation of sugar in the liver, bringing it 
quite up to our present knowledge of this function. 
And here we must compliment the professor's well- 
known powers of description, for, with the aid cf two 
wood-cuts and a few lines of text, we have not the least 
difficulty in recognizing his "comminuting machine'^ as 
the article so familiar to most eyes as a "fluting ma- 
chine." To those who have, (or the last five years, been 
familiar with the researches of Chrzonszczewsky and 
others on the origin of the bile ducts, as verified by Dr. 
Stiles of Brooklyn, {Third Annual Report of the Metro- 
politan Board of Health, 1868, p. 256-57) the coolness of 
the following quotation, from page 245, will be refresh- 



ing : " The exact mode in which these cells arc connected 
with the hepatic duct was for a long time the most ob- 
scure point in the minute anatomy of the liver. It has 
now been ascertained, however, by the researches of 
Dr. Leidy, of Philadelphia, and Dr. Beale, of London, 
that they are really contained in the interior of secret- 
ing tubules, which pass off from the smaller hepatic 
ducts, and penetrate everywhere the substance of the 
lobules. The cells fifl nearly or completely the whole 
cavity of the tubules, and the tubules themselves lie in 
close proximity with each other, so as to leave no 
space between them except that which is occupied by 
the capillary blood-vessels of the lobular plexus." 

The student, searching for information as to what is 
meant by the amoeboid movements of the white blood 
corpuscle, will fail to obtain, from the volume under 
consideration, an}'- intimation th;it this body is any- 
thing else than "globular in form" under all its normal 
conditions. It is also apropos to remaik that the ex- 
istence of this same white corpuscle outside the walls 
of the blood-vessels is not even hinted at in the shape of 
allusions to the existence of lymph, sahvary, or mucous 
corpuscles. In writing of the milk, colostrum corpuscles 
are mentioned, but nothing is said of the fact that they 
are identical with the so-called white corpuscle. No 
mention is made of the leucocyte in the article on the 
spleen, the minute anatomy of which consumes two 
pages, and the effects of its retnoval from the lower 
animals another. Not a word is said anywhere about 
the minute anatomy of the kidneys or the effects 
upon animals or man of their removal, by operation or 
disease, save in an aflusion to the effects of suppression 
of all of the excretions. On page 355 he says, " The 
kidneys, on the contrary, do not secrete anything, 
properly speaking, and are not, therefore, glands." 
What they are, he does not inform us. 

In the preface, the author says: "And accordingly 
the discussion of doubtful and theoretical questions has 
been avoided, as a general rule, in the present volume, 
while new facts, from whatever source, if fully estab- 
lished, have been added and incorporated with the 
results of previous investigations." It would have been 
interesting to students of physiology throughout the 
scientific world, if Professor Dalton had made an ex- 
ception to his general rule, and told them how he came 
by the decision of a question, which has for years been 
one of the most difficult problems they have had to 
solve, viz., the cause of the coagulation of fibiin, or on 
the other hand the cause of its remaining fluid. Robin 
and Verdeil abandoned the subject. Avith the assertion 
that it is "as vain to seek after the cause of this fact as 
to inquire why fibrin exists, why sulphate of copper is 
blue," etc. Professor D. has at length solved the prob- 
lem. "The answer to this que?tion," he says, " is as 
follows :— The fibrin remains fluid during the natural 
state of the circulation, because, like the other ingredi- 
ents of the blood, it is constantly undergoing clianges 
wdiich prevent its arriving at the state necessary for co- 
agulation." What the " states " are, to which the other 
ingredients of the blood must arrive, in order that then 
may coagulate, we all know of course — the chloride of 
sodium for example. " We can easily understand how 
tills should be the case," he continues, " when avc re- 
member, in the first place, the extreme rapidity with 
which the blood moves in the vessels of the living 
body. . . '. Secondly, the fibrin of the blood dis- 
appears while passing through the liver and the hidneijs. 
. . . . By calculating approximatively the quan- 
tity of blood contained in the whole body and that 
passing daily through the liver and kidneys, it is 
easy to estimate that a quantity of fibrin equal 
to 'that in the entire blood is destroyed and re- 



88 



THE MEDICAL RECORD. 



produced sevornl times over in the course of a single 
day. Thus the fibrin existing in the hlood at any one 
timo, is tliat which has been recently foniicd ; and be- 
lori' the time arrives at whieli it wouM naturally coag- 
ulate, while still in the vessels, it. has already been 
decouiposeil by its usu d metamorphosis in the circula- 
tion, and has l)eon replaced by a new supply of still 
more recent formation." Now not all of the fibrin in 
the body is coutaiued in the blood-vessels, but a very 
considerable proportion is to be found in the lymph, 
which moves in the largo vessels at a speed no greater 
tiian an inch in a second, and very much more slowly 
the nearer we anproach the periphery. Again, the fluids 
wliich we find in the serous and synovial cavities are 
known to contain, sometimes, fibrin in considerable 
amount; and tliese fluid-', under certain circumstances, 
undergo little or no movement, so far as can be demon- 
strated : surely they are not passed through the liver 
an<l kidneys at short intervals in order to undergo their 
"constitutional." IJow, then, is the fact that they do 
not coagulate while yet in the body to be accounted for? 

We now come to the function of respiration, and 
first arises the query how much influence is likely to 
be exerted on the diffusion of air in the bronchia by 
the movement? of so much of the cilia, (whose whole 
length is but 4,,'irii to 7v,VTTof an inch) as projects beyond 
the layer of mucus which covers the walls of these 
canals. 

The statement that the oxygen of the blood is present 
in solution in the blood globules, instead of in combina- 
tion with some of their elements, can hnrdlv be said to 
agree with the results of experiments by Bernard and 
others since 1859 ; nearly, if not quite, all of the writers 
since that period agreeing that it is in the latter con- 
dition. The quotation from Magnus, "'that the blood 
holds in solution 2i times as much oxygen as pure 
water could dissolve at the same temperature," is all 
very well as far as it goes, since this is about the 
amount held in solution by the plasma ; but as for the 
whole quantity of oxygen the blood is capable of con- 
taining, this statement gives only about one-tburth the 
amount now accepted. 

No mention whatever is made of the researches of 
Dr. Hutchinson, of England, with reference to the 
amount of air respired by an individual being a test of his 
his vital capacity — observations which are of daily use 
the examiner for life insurance. 

We simply note in conclusion, for we have already, 
we fear, transcended the bounds of the reader's for- 
bearance by the length of our remarks, that the capil- 
laries are spoken of as "simple, homogeneous, nucleated, 
tubular membranes." It occurs to us, that a nucleated 
membrane can hardly be called homogeneous ; and 
we call to mind the photographs and engravings of the 
epithelial cells forming these tubes, which, since Cohn- 
heim's experiments on the wanderings of the leucocytes, 
have become familiar to most of us. 

Remarking, lurther, tliat none of the researches of late 
years liave been added to the chapter on speciil senses, 
we bring our liasry ;iud incomplete review to a close. 

That we cannot give our indorsement to " the book, 
in its present form," as '• a faithful exponent of the 
acturd condition of nhysiological science," is, we suspect, 
pretty evident. We say this with regret, for, if we ex- 
cept English work-, there is not in this coimtry, at the 
present day, a complete treatise on Human Physiology 
available to the student and practitioner of medicine, 
not encumbered by a great deal of matter in which 
neither of these classes is particularly interested. It is 
our belief, that it is only this fact, and the protective 
tariff on foreign books, which have permitted the pub- 
lication of this fifth and stereotyped edition. 



DiAOUAMB OK THE NERVES OF THE HUMAN BODY, 

exhibiting their origin, divisions and connections, with 
their distril>ution to the various regions of the cu- 
taneous surface, and to all the umscles. By WlLLlA.M 
IlKMiY Fi-oWKU, F.R.C.S., Assistant Surgeon to, and 
Demonstrator of Anatomy at, the Middlesex Hospital. 
I'ilited, with addition.s, l)y WiM.AM W. Kkkn, M.D., 
Lecturer on Anatomy and Ojjorativc Surgery in the 
Philadelphia School of Anatomy, etc., etc. Phila- 
delphia: Turner Hamilton. 1872. 4to, pp. 11, with 
full-page lithographic plates in two colors. Price, 
$1.50. 

We are glad to see these standard diagrams placed 
within reach of American students and practitioners, in 
a form more convenient for use tlian the English (folio) 
edition, and at less than one-fourtii its expense. For 
presenting clearly to the eye the salient points of what 
is unquestionably to the average student the most diffi- 
cult, and so the most neglected, part of de8cri|)tive 
anatomy, they leave almost nothing to be desired. 
Where improvement on the original seemed possible, it 
has been made by Dr. Keen with the same clear, prac- 
tical. judgment which we had to thank, a year or two 
since, for the remodelling of Heath's Anatomy. That 
book, with his additions and modifications, a teacher of 
our acquaintance, who has given it two winters' trial 
in the dissecting room, pronounces the best working 
dissector in the English language. 

A Text-Book of Pathological Histology ; an intro- 
duction to the study of pathological anatomy. By Dr. 
Edwaud RiNDFLEisrn, 0.0., Professor of Pathological 
Anatomy in Bonn. Translated from the second German 
edition, with permission of the author, by William C. 
Kloman, M.D., assisted by F. I. Miles, M.D., Pro- 
fessor of Anatomy, University of Maryland. Phila- 
delphia: Lindsay it BlakLston. 1872. 

Ax Ixtuoductiox to Pathology and Mokbid Ana- 
tomy. By T. Henry Green, M.D.. London, Lecturer 
upon Pathological and Morbid Anatomy at Charing 
Cross Hospital Medical School. Philadelphia: Henry 
C. Lea. 1871. 

It may, we think, be asserted with truth that in no 
department of practical medicine has such materinl prog- 
ress been made of late years as in that of pathological 
anatomy. This progress has been so thorough that it 
has rendered the works published upon the subject ten 
or fifteen years ago almost valueless, or, at any rate, has 
rendered large portions of them utterly valueless, and 
has caused a more or less complete modification of the 
balance. It would seem that to Germany belongs the 
credit of thoroughly and laboriously studying patho- 
logy, and of bringing it to its present standard, and that 
the German mind, which works slowly and carefully, 
avoids theories and aims for truth, is specially adapted 
to the task of studying pathology, which can only be 
mastered by patient and long-continued observation. 
Previous to the publication of the volumes the title of 
which licad this article, pathological anatomy was in a 
very complex and unsatisfactory state in this country, 
and the same may be said of the state of our knowl- 
edge of normal histology. As text-books upon patho- 
logical anatomy we made use chiefly of those of Vogel, 
Cragie, Jones, Sieveking, Wedl, and Wilks, all of 
which were entirely too antiquated. Witli these ex-; 
ceptions, and perhaps some portions of works upon the 
practice of medicine, treating upon the subject, and the 
occasional translation or resume of an article on patho- 
logical anatomy in the journals, we were wdiolly desti- 
tute of a work embracing the whole subject, and in this 
connection we may add, that although Virchow's work 
on Cellular Pathology treated of tiie subject, yet as it 
was devoted to a theory and did not embrace the whole 



THE MEDICAL RECORD. 



89 



subject, it failed of the purpose of a text-book. The 
great cause of tliis want of a text-book upon patholog- 
ical anatomy, we think, lies in the fact that as this 
subject is not systematically taught in our schools, the 
interest which it should exercise was wanting, and 
hence the profession paid only slight attention to it. This 
absence, in our curriculum of medical study, of thorough 
means to convey instruction in pathological anatomy, 
is one of our moat serious drawbacks. In days gone by 
the absence of such instruction was unavoidable, as 
there was in reality no one sufficiently accomplished in 
ihe branch to constitute instructors in it; but now, 
owing to the enormous facilities offered in G-erman 
universities, many of our countrymen are fully able, 
as evidenced by the publication of their own observa- 
tions, to teach students of medicine this very essential 
branch thoroughly. It is true that many of the details 
of pathological anatomy are taught en courant in the 
courses on surgery and on the practice of medicine ; but 
pathological anatomy is a subject which certainly can- 
not be imparted by viva voce teaching, and can only be 
thoroughly mastered in the laboratory under com- 
petent instructors. Of late years the numerous able and 
important monographs upon pathological anatomy 
which have been published in the German medical 
journals, particularly Virchow's Archiv, have greatly 
interested the thinking portion of the profession on this 
side of the water, and there has existed a real desire 
for a lull treatise upon this subject. In looking through 
the massive treatise of Rindfleisch, a variety of thoughts 
suggest themselves, while we are amazed at the im- 
mense wealth of knowledge stored up in it. We pain- 
fully appreciate the fact that, owing to their deficient 
education, how few practitioners are there who Avill be 
able to really ma?ter its contents; whereas, if they had 
been carel'uUy instructed in this branch in their rudi- 
mentary education, what an amount of knowledge they 
could attain. The appearance of this book, with its 
diversity of subjects, its minuteness of inquiry, and the 
light which it throws upon such a multitude of patho- 
logical processes as are treated of in it, shows us really 
how little we know, and how as yet the majority of 
physicians are not sufficiently educated up to it. We 
really hope that ere long pathological and normal 
histology will be thoroughly taught in all of our 
colleges, and then the value of a treatise like this of 
Rindfleisch will be increased fourfold. 

Rindfleisch divides his work into two parts ; a gen- 
eral part and a special part. The general part contains 
a lengthy description of the decomposition and de- 
generation of tissues, including necrosis and involution, 
and the vnrious forms of infiltration. This chapter 
covers a wide range, and treat? fully of amyloid infil- 
tration, calcification, pigmentation, and fatty infil- 
tration. The second chapter of the general part treats 
of that important part of pathological histology, namely, 
the pathological new formations. Following a very 
succinct review of the various cell-theories entertained 
by i^rominent German authors, we find a very instruc- 
tive consideration of normal growth as a type of patho- 
logical development. This very naturally leads to a 
general consideration of inflammation, Avhich also in- 
cludes a study into the nature of specific inflammations. 
After this follows a short but admirable description of 
the morbid processes taking place in the development 
of the various tumors, which is amply illustrated by 
drawings of sections of the various growths. 

In his second part Rindfleisch speaks of the lesions of 
each apparatus and organ separately under the geneiic 
title of anomalies of tiiem. Thus we have — anomalies 
of the blood and the places of its formations, especially 
of the spleen and lymph glands ; anomalies of the cir- 



culatory apparatus, of the serous membrane of the skin; 
of mucous membranes, of the lungs, of the liver; of the 
kidneys; of the ovaries; of the testicles; of the mamma; 
of the prostate; of the salivary glands; of the thyroid 
glands ; of the supra-renal capsule ; of the osseous 
system ; of the nervous system ; of the muscular system ; 
and finally the volume concludes with a copious index 
and bibliography. To analyze such a work thoroughly 
would require much more space than is at our com- 
mand, and we shall confine ourselves to briefly pointmg 
out some portions of the work whicli we think are of 
more than ordinary interest. Thus the chapter upon 
the anomalies of the blood includes a fidl review of the 
interesting subjects of the dyscrasi;c, chlorosis, leukte- 
mia, and melanajmia, and also a fidl description of 
thrombosis, which is particularly interesting in a clinical 
point of view and is ably written. The anomalies of the 
skin are fully naticed, and in that chapter persons in- 
terested in dermatology can find much profitable inform- 
ation. The forms of catarrhal and croupal inflammation 
are clearly described in the section upon anomalies of 
the mucous membranes. We know of no work or 
monograph to which our readers can refer where they 
will find all the recent views upon the various forms of 
lesion of the lungs as they will in Rindfleisch's article 
upon that subject. We can say the same of the chapter 
upon the anomalies of the liver, and must call particular 
attention to the admirable chapter upon the anomalies of 
the kidneys, a subject which has lilt ely attracted consider- 
able attention in this country, and which is here treated 
of in a masterly manner. Though all the chapters are of 
very great merit, we will still call particular attention 
to those upon the anomalies of the osseous and nervous 
system as being particularly interesting to physicians 
and surgeons. In considering such organs or apparatus, 
the author fully treats of it in a condition of inflamma- 
tion, so that in the book we have the fidlest account of 
that complex process to be found anywhere. The style 
of Rindfleisch is terse and clear, but avc must greatly 
regret that his work has not been well translated. As 
we read the volumes we are struck with the peculiar 
construction of the sentences and general lack of smooth- 
ness of the diction. In fact it suggests to the reader the 
idea that its translators are not thorough German 
scholars, and that they frequently have to make use of 
the dictionnry. The general appearance of the work is 
highly creditable to the publishers, and we are pleased 
to see the illustrations so well done. 



Dr. Green entiiles his work an Introduction to Patho- 
logy and Mcrbid Anatomy, and with great modesty 
states in the preface that he has endeavored to supply 
a want greatly felt, and that he wishes it to be con- 
sidered as a simply elementary work. He goes over 
the subject in hand quite clearly, and his work is writ- 
ten in a very pleasant manner; but the reader is con- 
tinually struck with the fact that it is too brief, and 
that the author does not do full justice to the important 
subjects treated of If in a future edition the author 
amplifies his work, we think, it will be really valuable. 
We think he has taken the excellent French mnnual of 
Cornil and Ranvier as his model, and that he would do 
well if he treated of his subjects as fully as they are 
treated of by those authors. 



Criminal Adortion. — Tiie detention of criminal 
abortion and a study of foeticidal drugs are ably pre- 
sented by Ely Van de Waiker, M.D., of Syracuse, 
N. Y., in "^a monograph of eighty-eipht pages, being a 
reprint from the Gyneecological Society of Boston. 



90 



THE MEDICAL RECORD. 



Ueports 0f Societies. 



MKDIOAL SOCIKTY^ OF THE COUNT\' OF 
NEW YOKK. 

Siaied Meetin>/, February 26, 1872. 

Dr. Abkaiiam .lAooni, Pkksidkst, in tl.c Chair. 

The following pliysifians, recommended by tlie Comi- 
tia Minora, were elected to membersliip : George H. 
Humphreys, Kdward C. Woodbury, William M. Bal- 
lard, Carlos P. Tucker, Alexander F. Liautard, Chailcs 
A. T. Krop, James Mitchels, J. W. S. Arnold, Edwin D. 
^^orJTan, Jr., liobert S. Prentiss, Thomas IL Pooley, 
Horatio Gomez, and Gilbert II. Swezey. 

The Pkksident stated that the followincr work had 
been donated to the library by its autlior, and ho was 
instructed to make suitable acknowledgment: "Die 
Gejchiehte der Psychologic nnd der I'sychiatrik in 
Spanien, von Dr. J. B. Ullersperger, Wiirzburg, 1S71." 

Dr. p. p. Porter, from the Committee on Intelli- 
gence, read an interesting report of recent progress in 
Theory and Practice of Medicine. 

Dr. II. Ai.TMoF, from the same committee, read a por- 
tion of a long report on the progress of Ophthalmology 
during the past year. The conchu-ion of his report, 
and another report expected from the committee, Avere 
postponed to the next meeting. 

mkteorology of nine months. 

Dr. D. II. Goodwillie, chairman, presented the fol- 
lowing report of the Committee on Meteorology : 

May 20 to September 3, 1871. 

Barometer : mean 29.87 inches ; maximum, May 2d, 
30.234 inches; mininuim, June 12th, 29.438 inches. 

Thermometer: mean, 71.91'^ Fahr.; maximum, July 
10th, Or' ; minimum. May 23d, 54. 

Rain fell on 35 of tlie above 105 days, making an aver- 
age of rain on every third day. On 22 of the 35 rainy 
days tliere were thunder-storms. In July rain fell on 14 
days, and on 10 of these was accompanied by thunder 
and lightning. Hail July IGth. June 18th, rain to the 
amount of 2.98 inches, and at 9.50 p. m. a slight shock 
of earthquake. Whole amount of rain during the 105 
days, 21.35 inches. 

September 3, 1871, to February 4. 1872. 

Barometer: mean, 29.65 inches; maximum, Sep- 
tember 12th, 30.324 inches; minimum, January 23d. 
29.592 inches. 

Thermometer : mean, 43.24** ; maximum, September 
9th 68® ; minimum, January 30th and 31st, 10". 

Rain on 26 days, .snow on 7. Thunder-storm Sep- 
tember 2Gth. Whole amount of rain, 18.00 inches. 

dise.\ses of eight weeks. 

Dr. Ch.\p.le3 p. Russel, Chairman, read the report 
of the Committee on Diseases : 

The Committee on Diseases have the honor to pre- 
sent the following report upon the prevalent diseases 
in this ciiy from January 1st to February 24th of the 
present year— embracing a period of eight Aveeks : 

During that time there were reported to the Bureau 
of S;mitary Inspection 596 cases of small -pox. 123 of 
measles, 613 of scarlatina, 119 of diphtheria, 17 oftvphus 
fever, and 54 of typhoid fever. " I 

The total registered mortality for the eight weeks I 
amounted to 4,294, a weekly average of 537. During 



the corresponding period of tlie past year there were 
registered 3,996 deaths — a weekly average of 500. 
Tiic highest wickly average for the conespnnding 
period of cither nf the live pr-.-ceding years was 509 in 
1870. Thus far, therefore, the mortality of the prc.«ent 
year has been much in excess over that of recL-nt 
years. 

The greatest mortality occasioned by any zymotic 
disease has been produced by smnll-piKr, namely, 192 
deaths, a Aveekly aA'crage of 24. It has lluctuated be- 
tween 15 and 32 deaths weekly, with no appanMit ten- 
dency to diminish. Its proportion of mortality, as 
deduced from a comparison of the number of ca.se8 re- 
ported Avith the number of deaths registered, has been 
32 in the 100. This ])ercentage, however, is doubt- 
less too large, as many non -fatal cases escape the ob- 
servation of the Board of Health. 47 deaths have 
been due to measles — about 6 weekly — a .small number. 
ScurJalina has carried off 190 persons, somewhat more 
than in the coriesponding period of the past year. 
Both of tlie two latter diseases .seem now to be slightly 
on the incrca.se. 00 deaths have been ascribed to 
diphtheria, and 118 to croups about the usual number. 
Whoopiuy-congh has continued very prevalent, its fatal 
cases having amounted to 165, over 20 per week. Ty- 
phus and typh'iid fever have both been marked by a 
very small mortality, having caused but 13 and 34 
deaths respectively. 30 liave been occasioned by 
remittent fever, an excessive mortality lor the season. 
15 i deaths have resulted froin diarrhfral diseases against 
145 in the corresponding period of 1871 . The number of 
deaths from phthisis puhnonalis Avas, until quite latel}', 
comparatively small, much below that in the early por- 
tion of last year. But, during the past week, this dis- 
ease exhibited a most extraordinary f itality, its deaths 
reaching 122, the greatest weekly number ever re- 
gistered in this city, the next largest having beenil02, 
in the week ending March 4, 1871. The deaths from the 
local respiratory affections likewise seemed to participate 
in the same unfavorable influences, as they occa-ioned 
105 deaths during the week, their Aveekly average having 
been only 85 since January 1st. 

Twenty-five cases of epidemic cerebrospinal menin- 
yitis, or spotted fever. haA-e thus far been reported, of 
which 12 have proved fatal. These cases have oc- 
curred, almost Avithout exception, in houses of the 
very worst hygienic character and surroundings, and 
generally in tenements particularly defective as regards 
drainage and scAverage. Whether such circumstances 
are directly concerned in the production of this peculiar 
disease is certainly a question of vast interest to the 
profession. 

CLINICAL THERMOMETRY. 

Dr. Lccirs D. Bulkley read a long and elaborate 
paper upon this subject, illustrated by numerous raural 
diagrams and tal)le.s. The paper was based on the 
essay to Avhich ^A-as awarded the Stevens Triennial 
Prize two years ago, and its purpose was not to present a 
history of clinical tliermometry. or an epitome of what 
it had accom[)lished, but rather to contribute neAv data 
for the thermomctrical study of disease, in a s5\siema- 
tized record of the experience of the New York Hos- 
pital for the three j'ears prior to August, 1809, and to 
state briefly the conclusions which that experience 
tended to establish. 

The number of cases in Avhich a record of tempera- 
ture was regularly kept amounted to 337, classified as 
follows : typhoid fever, 93 ; typhus fever, 23 ; pneu- 
monia, 64; erysipelas, 24; acute rheumatism, 17; re- 
mittent fever, 12; intermittent fever, 7; scarlet fever, 
7 : phthisis, 19 ; acute meningitis, 9 ; tonsiliiis, 7 ; peri- 



THE MEDICAL RECORD. 



91 



tonitis, G; miscellaneous, 49. Besides the temperature, 
the pulse and respiration were always recorded, and the 
doctor had tabulated all the cases under each disease 
with reference to these three vital signs. Forty or 
fifty of those most interesting, either from their typical 
eliaracter or from some other circumstance, were given 
in detail, with diagrams showing the curves of the 
three signs. Each diagram was the record of an actual 
case, and faithfully exhibited every failure of observa- 
tion ; there were no typical curves made up from the 
generalization of many cases, as in AVunderlich's book. 

The nature of the paper piecludes any extended ab- 
stract, but we hope to see it published as a monograph. 
It is quite time that the wealth of experience, so long 
carefully hoarded in the case-books of the New York 
Hospital, should be brought out for the use of the pro- 
fession. We here confine ourselves to the doctor's 
concluding summary of the chief points he considers 
established : 

" 1. T!ie body heat is maintained in health, under all 
conditions, at the uniform standard of 98.4° Fahr. 

" 2. Any constant deviation from this constitutes dis- 
ease. 

" 3. A return to and continuance at this standard 
marks the termination of the disease. 

" 4. A single high temperature is important. 

" 5. The changes of temperature in diseases follow 
definite and known courses. 

" 6. Variations from these typical ranges of temper- 
ature in disease are significant, as indicating a disturb- 
ing cau~e. 

" 7. An irregular course is more unfavorable than a 
uniformly higli range of temperature. 

" 8. Different temperatures characterize different dis- 
eases, and various days of the same disease. 

" 9. Although a high temperature indicates a more 
severe attack, no heat under 109° can be considered 
surely falal. 

'■ 10. The daily study of the pulse and respiration in 
connection with the temperature is of great assist- 
ance. 

'"11. When the temperature and general symptoms 
agree, but the pulse disagrees, the two former are to be 
relied on. 

" 12. When the pulsa and general symptoms agree 
in indicating unfavorably, the temperature cannot be 
relied on, if contradictory, unless the improvement in 
respect to temperature is marked and persistent. 

" 13. When pulse and general symptoms agree in a 
favorable indication, a liigh or rising temperature 
should arrest attention. 

" 14. All other means of investigation should be 
used in connection Avith the temperature to obtain the 
greatest benefit from the latter. 

" 15. The continuous daily record of the three vital 
signs here represented, in the way exhibited, affords 
much aid in the diagnosis, prognosis, and treatment of 
disease, by the presentation to the eye of its history in 
these res[)ects. 

" IC. The systematic record of these three points 
may assist in determining, at some future day, the 
vexed cpiestion whether the type of disease is chang- 
ing, by preserving pictures which can be easily com- 
pared." 

THE ALBANY MEETING. ' 

Dr. E. Eliot, as one of the delegates to the recent 
meeting of the State Society, gave a summary of its 
proceedings. 

The Prksidf.xt wished to direct special attention to 
the following lesolution adopted at that meeting, and 
hoped each member would do his part toward inducing 



every respectable practitioner in the county to join the 
County Society : 

^'licsolued, As the old laws, requiring every physician 
in good standing to become a member of his county 
medical society, have not been repealed, it is, and 
always has been, the duty of every sucli physician to 
obey tne law ; and as the penalty for non-compliance 
has been removed by law, it becomes a jxnntof honor 
for every regular physician to do so. The presidents 
and officers of every county society in the State of 
New York are requested to use their best efforts to 
have these laws complied with." 

With reference to the special meeting of February 3d, 
the President said that he had been obliged to call it 
in accordance with the by-law providing that such a 
call shall be made on the written request of twenty 
members. Twenty-four names appeared on tiie re- 
quest; t\venl3'-seven members attended the meeting, 
and of these only five were signers of the call. A 
meeting so attended, after full notification, could hardly 
be considered to have been a public necessity^- and it 
behooved those members whose politeness would not 
allow them to refuse an individual their signatures, to 
reflect whether they had not also some duty to the 
Society m a matter involving expense and the conve- 
nience of a large body of physicians. 

Adjourned. 



Correspontrencr. 



BATHING REDUCED TO A SCIENCE. 

To The Editor of the Medical Record. 

Sir : — It is always pleasant to couple reminiscences 
with prospects, particularly when it permits to do 
justice to the men of the past as well as to those who 
represent the nearest future. Tlie last pamphlet of 
Dr. Wilson Fox offers the opportunity of doing both. 
In seventy-eight pages lie gives several monographs 
illustrating cases of acute rheumatism exclusively 
treated by temperature as a remedi/, and almost exclu- 
sively managed by temperature as a means of positive 
diafjiiosis. 

Acute rheumatisms in which, after a course of variable 
severity, the temperature suddenly rises from 103°, 104° 
to 107°, 108°, 109° F., have so often proved fatal within 
a few hours after reaching the latter degrees, that 
Wunderlich legards them as pro-agonistic. The uni- 
formity of this termination, whatever plan of treat- 
ment had previously been followed, induced Dr. W. 
Fox to try to treat it exclusively by low temperature?. 
He pubhshed last year in the London Lancet veiy 
interesting accounts of his first trials; and now details 
his success in two cases which had reached, respec- 
tively, 110® and 107.3° F. ; both being primary attacks 
of the disease, Avhich are more commonly fatal. Dr. 
W. Fox does not, however, present his treatment by 
temperature as a remedy exclusively adapted to rheu- 
matism, but as the remedy for hyperpyrexias at large. 
Thereupon the question suggests itself, "What Avill be 
the next move?..." An essay on the Trentment of 
Apyrexia? . . . Then what becomes of the innumeni- 
ble diseases of modern ncsographies in a therapeutic 
point of view ? . . . Evidently the subject is too broad 
for the columns of a periodical. 

These monographs of Dr. W. Fox deserve besides 
to be studied as presenting the most complete speci- 
mens of diseases and recoveries in which the thermom- 
eter almost alone has done all the work of clinic and 



92 



THE MEDICAL RECORD. 



therapeutic, and the strongest practical indication of 
the revolution clearly expressed in the hook on Medical 
Tfinperiitiiie by C. A. Wunderlich and K. Scpnin (page 
23S), " Tiu-rmometry will soon rule, not only dingno- 
sis, but pathology^and thcrapeutios." To consider a 
single fact in this prospective revolution, it is interest- 
ing to see how Dr. W. Fox advocates and systematizes 
the use of water — not as water or as one of the palhies, 
but as a carrier of measurable or dosable temperature, 
acting pliysiologically in virtue of physical laws. 

To render general this application of wut t, Dr. W. 
Fox insists unon the introduction in the wards of hospi- 
tals of movable bath-tubs, in wliicli the patient could go, 
or be immersed, as near as possible from his own 
bed. This liappy sng^'estion recalls to mind a mode of 
bathing patients which ought not to have been for- 
gotten. 

'■ Les hiiins sans baignoire" was the title of a little 
pamphlet handed to me, in the summer of 18.'35 or '3G, 
by a gaunt and weatherbeaten Swiss physician during 
my introductory visit to him in a meager Iodizing of the 
Qnartier Latin. He was wrapped in one of those broad 
blue cloaks in wiiich the Old Guard are represented 
falling at Waterloo. Under this historical garment he 
was taking his bain sans bai'pioire in a double lial)it of 
flannel and water-proof lie never took anv other, 
enjoying them especially when going on horse-baok to 
visit his patients, several miles away; and the three 
hundred and oild patients of his hospital used the same 
bathing apparel for many years and liked it very much: 
indeed, there was not a single bath-tub in the hospital 
of Lauzanne. 

For mine host was ue of Avhom it has been said: — 
" There are two systems of surgical deligation, the one 
handed to us under the name of Hippocrates, the other 
Mayor's." He had come down to Paris to have one 
of his free liLrhts upon his proposed improvements with 
the old fogies of the Academy of Medicine, too nu- 
merous to mention : this was Mathias Mayor's yearly 
recreation. 

Now it seems to me that this forgotten bain sans 
baifjnnire would be just the thing which, with slight 
modifications, would render easy in hospitals, and pop- 
ular among the middle classes the treatment of hyper- 
pyrexia by medical temperatures, not only in public 
institutions, boarding-schools, naval, military, industrial, 
and s:ientific expeditions, etc., but in the homes of the 
many who have no bathing facilities. The apparel 
would consist of a litrht stand, like the foot-step used 
in a library, upon which could be set a covered reser- 
voir of a few gallons, having inserted in one of its sides 
a rib of glass, showing the level of the liquid, and an 
ordinary thermometer to regulate the temperature of 
t'le latter. Hence, one pipe or more would let down 
the water into the bathing-dress. 

This dress — which entirely enrobes the patient, even 
if need be his head and some parts of Ids face — is 
double, of thick flannel against the skin, and of vulcan- 
ized cloth outside. It is also open in the centre, like a 
pouch, to permit the insertion of the medical thermom- | 
eter in one of the natural cavities, at various points to \ 
admit the water from the reservoir, and at the feet and j 
other declive parts to give issue to the liquid iuto i 
covered receivers below. 

This bathing-dress could be made as stout or as light I 
as desirable; it could be so adjusted as to hardly hold 1 
two quarts of Avater, pure or medicated ; mathemat- j 
ically warm or cold as per thermometer; stagnant ] 
around the body or streaming along it. It could be i 
worn for hours, or days, in bed by the paralytic and ; 
rheumatic patients, or in the room, even in the open ! 
air by iho.«e who need at the same time bathing and . 



exercise. There are many other advantages of this 
bathing-dress too obvious to need mentioning. 

The •' apparatus for applying heat and cold to the dif- 
ferent parts of the human body,"descril)('d liy Dr. Alex- 
ander Kol)ertson, of Glasgow, in the TiOiKlon Medical 
Times (Did dazetle of January lijth, 187-, sccmiis more 
ingenious than the one here juoposed ; but iheir appli- 
cation and object differ so entirely, that where the one 
would be useful the other one would be u>elc.ss; but 
both could certainly find their place in hospitals and 
ambnlances, or be easily supplied to private patients. 

Such appears to be, prima facie, the advantages of 
the adaptation of Mayor's balh to the therapeutics of 
the positive school of medicine of which Dr. W. Fox 
is, with his kinsman. Long Fox, one of the most noted 
exponents. 

It seems that it would be doing an act of justice if 
we were giving to this bathing npparel the name of 
Mathias Mayor, who was never equalled for ingf-nuity 
in the mechanical department of surgery ; and yet who 
met with so little of reward that, if he had cared a fig 
for a tomb-stone, he Avonld have caused to be written 
upon his, '■ Woe to him who comes too soon." 

There may be protests against the positions respec- 
tively here assigned to Mathias Mayor and to Dr. W. 
Fox. Dr. Richard Neale presents his own titles in the 
London Medical 'Times and Gazette, Feb. lU, 1372, as 
having applied the water treatment under cover of 
plantain leaves, etc., and there may be hundreds of ap- 
plicants to such claims as his; for, since Priessnitz and 
Fleury, the iiydropathist of the late French court, back 
to Antonius Musa, the famed hydrotherapeute of the 
emperor Augustus, water was uninterruptedly used as 
an empyrical remedij. But none used it prior to these 
later days as a positive remedy giving mathematical 
results : this is what the school to which Dr. W. Fox 
belongs pretends to; and to which the bathing appa- 
rel of Mathias Mayor may prove valuable. 

RespectfuUv Yours, 

E. S. 
Xew York, Jtarch 0, 1&T2. 



ARMY NEWS. 



Official List of Changes of Stations and Duties nf Offi- 
cers of the Medical Department, United States Army, 
from February 21, 1872, to March 4, 1872, inclu- 
sive. 

WiRTZ, H. R., Surgeon. — By S. 0. 3, Department of 
Arizona, January 15, 1872, assigned to duty at Camp 
Hualpai, A. T. 

Fraxtz, j. IL, Surgeon. — By S. 0. 40, Departmei^it 
of the South, Februar}'^ 24, 1872, assigned to dutv at 
Columbia, S. C. 

Macicin, Chas., Ass'stant Surgeon. — By S. 0. 40, 
Department of the South, February 24, 1872, assigned 
to duty at Fort Macon, N. C. 

Bartholf, j. II.. Assistant Surgeon. — By S. 0. 40, 
Department o! the South, February 24, 1872, assigned 
to duty at Chester, S. C. 

Lauderdai.-:, J. V., As«is'ant Surgeon. — By S. 0. 4G, 
War Depai tnient, A. G. , February 24, 1872, granted 
leave ol ab ence fur thirty days, with permission to 
apply for sixty days' extension. 

PowKLi,, R., Assistant Surgeon.— By S. O. 28, De- 
partment of the Gulf, February 20, 1872, a-s'gned to 
duty at Jackson, Mis.«., relieving Assistant Surgeon A. 
A. Yeomans, U. S. A. 



THE MEDICAL RECOED. 



93 



Kimball, Ja?. P., Assistant Surgeon. — By S. 0. 42, 
War Department, A. G. 0., February 19, 1872, to pro- 
ceed without delay to New Orleans, La., and report to 
the Department Commander. 

CowLES, Edward, Assistant Surgeon. — By S. 0. 44, 
War Department, A. G .0., February 21, 1872, Lis 
resignation accepted, to take efFect March 1, 1872. 

EDWAi:ns, L. A. Surgeon.— By S. 0. G3, War De- 
partment, A. Gr. 0., March 14, 1872, reheved from duty 
in Department of Texas, to proceed to Philadelphia, 
Pa., and thence repoit to the Surgeon-General. 

IIamjcond, John F., Surgeon. — By S. 0. 63, War De- 
partment, A. G. 0., March 14, 1872, to report to the 
Commanding General, Department of Texas, for duty 
as Medical l3irector. 

WiRTZ, H. R., Surgeon.— By S. 0. 60, War Depart- 
ment, A. G. O., March 11, 1872, upon arrival of Assist- 
ant Surgeon Girard, in Depanment of Arizona, to re- 
port to the Commanding General, Department of Cali- 
fornia, for assignment to duty. 

Bache, Dallas, Surgeon. — By S. 0. 57, War Depart- 
ment, A. G. 0.. March 7, 1872, relieved from duly in 
Department of Texas, and to report in person to the 
Surgeon-General. 

Ascn, M. J., Assistant Surgeon. — By S. 0. 61, War 
Department, A. G. 0., March 12, 1872, granted leave 
of absence lor six months. 

McElderry, H., Surgeon.— By S. 0. 61, War De- 
partment, A. G. 0., March 12, 1872, after accompany- 
ing the first detachment of recruits sent to the Pacific 
Coast from New York, to report in person to tlie Com- 
manding General Department of the Columbia, for as- 
signment to duty. 

Girard, J. B., Assistant Surgeon. — By S. 0. 60, War 
Department, A. G. 0., March 11, 1872, to report to 
the Commanding Officer, Department of Arizona, for 
assignment to duty. 

Kimball, James P., Assistant Surgeon. — By S. 0. 33, 
Department of the Gulf, March 4, 1872, assigned to duty 
at Little Rock, Arkansas. 

Mofj'att, Peter, Assistant Surgeon. — By S. 0., GO, 
War Department, A. G. O., March 11, 1872, assigned 
to temporary duty at Newport B'ks, Ky. 

KixG, J. IL T., Assistant Surgeon.— By S. 0. 62, 
War Department, A. G. 0., March 11, 1872, to report 
to the Commanding General, Department of the Piatte, 
for assignment to duty. 

CoRSox, J. K., Assistant Surgeon. — By S. O. 20, 
Middle Division of the Mo., leave of absence extended 
thirty davs. 



iHctiical Jtcms antr lletus. 



■ University Medical College, N. Y. — Dr. Joseph 
W. Howe has been appointed clinical Professor of Sur- 
gery ; Dr. Henry S. Hewit, Professor of Clinical Surgery ; 
Dr. Arnold, Professor of Pathological Anatomy ; and 
Dr. Kammerer, Professor of Diseases of Women and 
Ohildren, vice Dr. F. D. Lente, resigned. 

The Pharmacy Bill has been reported favorably 
from the Health Committee of the Assembly. Dr. 
Loughran, of Kingston, the Chairman of that Commit- 
tee, we are happy to say was one of the principal 
means to that end. 



Acid Syrup of the llYPOpnospiiiTK of Ltme in Vomit- 
ing OF Pregnancy. — Dr. A. F. Paitce, 13oston, sp(;aks 
very highly of the use of this syrup in the obstinate 
cases of vomiting in pregnancy. The dose ranges 
li'om 3j-5^s, given with the Ibod, three or lour times 
a day. 

The Alumni Association College of Physicians and 
Surgeons held its annual meeting at the College of 
Physicians and Surgeons, Tuesday, Feb. 27, 1872. The 
meeting was called to order by the Vice-President, 
Dr. C. R. Agnew. After the reading of the minutes 
of the previous meeting by the Secretary, Dr. John 
Shrady, the same gentleman read the obituary record. 
The Prize Committee through its Chairman, Dr. Gur- 
don Buck, announced the award of the Alumni Prize 
of four hundred dollars, to Dr. Frank P. Foster. The 
election of officers was then held with the following 
result. President, Dr. C. R. Agnew, N. Y. ; Vice- 
President, Dr. Robert A. Barry, N. Y. ; Secretary, Dr. 
John Shrady, Harlem, N. Y. ; Assistant Secretary, 
Dr. A. Norton Brockway, Harlem, N. Y. ; Treasurer, 
Dr. J. L. Banks, N. Y. 

The President. Dr. E. M. Hunt, of Metucliin, N. J., 
gave a scholarly addiess upon the past and present in 
medicine which was full of wholesome reflections and 
suggestive thoughts. The address was ordered to be 
printed. 

A discussion then arose bearing upon the expedi- 
ency of increasing the usefulness of the Association by 
making the reunions partake more of a sociable charac- 
ter. The sentiment of the meeting was in favor of 
refreshments, and the whole matter was left to a com- 
mittee to whom Avas voted the usual discretionary 
power. The meeting then adjourned. 

Bellevue Hospital Medical College. — The follow- 
ing changes have lately been made in the Faculty : — 
Prof. Stephen Smith has resigned the chair of Descrip- 
tive and Comparative Anatomy, and Clinical Surgery. 
Prof. B. W. McCready has resigned the chair of Mate- 
ria Medica and Therapeutics and Clinical Medicine, and 
has been appointed Emeritus Professor of Materia Me- 
dica and Therapeutics and Professor of Clinical Medi- 
cine. Prof. A. B. Crosby has been appointed Professor 
of General, Descriptive, and Surgical Anatomy. Prof. 
Wm. A. Hammond has been appointed Professor of 
Materia Medica and Therapeutics, Diseases of the Mind 
and Nervous System, and Clinical Medicine. Prof. 
Hammond will continue his lectures and clinics on Dis- 
eases of the Mind and Nervous System as heretofore, 
lecturing also upon Materia Medica and Therapeutics. 
Dr. E. G. Janeway has been appointed Prof of Patho- 
logiS,l and Practical Anatomy. As Prof, of Pathological 
Anatomy, he will deliver in the regular session a course 
of lectures on that subject. As Prof of Practical Ana- 
tomy, he will perform the duties of Demonstrator of 
Anatomy. Dr. E. L. Keyes, formerly Lecturer on Der- 
matology, has been appointed Prof, of Dermatology. 
Prof A. B. Mott has been transft-rred from the chair of 
Surgical Anatomy, with Operative and Chnical Sur- 
gery, to the chair of Clinical and Operative Surgery. 
Prof. Mott will relinquish his didactic lectures on Sur- 
gical Anatomy to the Prof, of Anatomy, and will hold 
a Surgical Clinic at the college throughout the year. 

College of Prysicians and Surgeons. — Beecher's 
Address. — The following extracts from our notes of 
Kev. Henry Ward Beecher's address to the graduates, 
at the Commencement of this college, could not find 
sjiace in the last number. 

After encouraging the students to work earnestly and 
wait patiently for opportunity, recognition and dis- 



04 



THE MEDLCAL REC;ORI). 



ti net ion, sure that finally success would follow desert, 
tlie speaker touched upon the motives that should im- 
pel ati'l Hiistain them. Tiie desire of pain, personal 
ambition, love of seientific truth, synipaihy for indi- 
vidual suftVrincr, an 1 tin; broader sentiincMit of pliilan- 
thropy, reinforced by religion, were tiie steps liy which 
I hey could mount to a plane of high thought and worthy 
action. 

The spread of cidture among the common people was 
rapidly changing the status of the medical profession, as 
of every other, eurlailing its lower functions, to extend 
and muUi|>ly its higher ones. " Take my own pro- 
fession," said the speaker. "There was a time when it 
was hardly right for a man to be born without the 
priest to sanction it; and all throujih life, at every turn, 
he must call in the priestl}- aid and counsel. Now, men 
not only are born, but t'.iey marry and die Avithout our 
help; tliey have appropriated to themselves a thousand 
oftices that were once our sacred and exclusive privilege. 
But we have gained far more than we have lost ; have 
been deprived of those manifold duties which were 
hindrance*, only to give us freedom for broader and 
higher growth ; and I rejoice in it. So in medicine. 
The intelligent mother is now your rival. The laily 
know more than the wisest of you did two or three 
centuries ago. Yet the field of your own work is not 
narrowed, but marvellously enlarged ; and it is destined 
to be extended more and more with the advance of 
science and it«s popular recognition. It was thought 
that machines would throw the workman out of em- 
ploy, but instead they only took slave's toil out of his 
hands, and drove him into better service, for which 
they created a new and ever-growing demand. 

"You are no longer to be simply ministers of healing 
to the sick ; a large part of your future duty is to be 
toward the well. The community looks to you to 
develop and enforce the whole science of private and 
public hygiene ; it looks to you, moreover, for instruc- 
tion in mental and moral philosoph}'. 

" I do not undertake to say that mental philosophy 
will ever be established upon the basis of physiology 
alone ; but I do say that without the support of phy- 
siology there will never be a stable philosophy. While 
I believe there is much more blossoms out in mind 
than mere nerve-substance, yet I believe, also, there are 
no men in our day so near the secrets to be revealed 
as the physiologists, nonC who are so likely to help us 
throw light upon the mysteries of intelligence it>elf. 

" I said you were to rectify our moral philosophy 
as well. Tiie law of God was not all written on !Mount 
Sinai ; He has been writing upon every mountain since. 
All of truth is not contained in the inspired record. 
God has not ceased to think, or to reveal his thougli^ A 
part of this revelation is in our own physical constitution ; 
and in the progress of truth we are to learn what is the 
connection between bodily conditions and moral states. 
I say, as the result of long observation and experience, 
that, very largely, the causes of wrong-doing are mor- 
bid conditions of body and unfavorable circumstances. 
We need not fear that this doctrine will destroy respon- 
sibility. There is enough in the fact that men know 
when they are doing wrong to secure that. I aver, 
then, that a sick man can hardly be a moral man ; can 
hardly conduct himself as a free moral agent, when 
every nerve and fibre of his body is crowding tempta- 
tion upon him. There is sin enough in one single 
organ, the liver, to call it the devil's den. You are to 
interpret for us this connection between physical and 
moral disease ; to help us clear the way for larger con- 
ceptions of life and duty. 

" It is impossible that the mass of men can be healthy, 
and so moral and successful, without some knowledge 



of their structure and of its laws which they must obey 
or KufTer. How can a young woman he called educated 
who is ignorant of physiology, of iier duties as a mother, 
of the divine art of nursing? How numy men know 
anything of th(! relations of waste and supply in the 
nervous economy? Why, not one man in a hundred 
knows even what the stomach is made for, and the 
other ninety-nine are constantly transgres.-ing rules 
they have never learned. We may take the old para- 
ble of the apple in the garden as an illustration of the 
way men's stomachs make havoc with their moral sense. 
Not one man in a hundred knows or suspects that God 
made the air to be breathed. Every part of his house 
may be reeking with miasma, the cellar full of all evil, 
the partitions clotted with dormant mischief, and he 
never dreams of it, but goes on nailing down his win- 
dows and listing his doors. If we could only see the 
air we have once breathed over! Even the architects 
of our public halls and theatres and churches have the 
crudest notions of ventilation. I have found .=ad proof 
of this in every part of the L'nited States, and you will 
agree with me that we have no exception here to-night. 
To whom shall we look for the diffusion of knowledge 
on these subjects among the people, if not to you? 
Every family in which you practice should be made a 
medical school. 

" From private hygieric, we pa=s to public, which we 
have hardly begun, as yet, to understand and apply. 
You must take the lead in directing the removal of 
those great morbific influences that prey upon the life 
of the community. Thousands upon thousands of 
cradles are yearly emptied, long streets are turned into 
shambles, from causes that should not be suffered to ex- 
ist. The great questions of the sewerage of cities, the 
draining of morasses, and a hundred others, are pressing 
upon us for answer; and of whom have we a right to 
demand it, if not of the medical profession? 

" It devolves, then, upon the physicians of this age to 
make themselves felt as a power in public as well as in 
private. In every 'effort to elevate the standard of 
personal purity ; in every discussion of the best means 
of preventing crime ; in every attempt to gain a soimder 
philosophy of education, and to apply it in the direc- 
tion of public institutions, or in the training of individual 
children — the physician is to be not only the adviser of 
the family, but also the counsellor of the community, 
whose word should be heeded as always important and 
often decisive." 

S.MALL-POX in New York still holds the weekly ave- 
rage of seventy-four. 

Dii. B. F. MiESSE, of Chillicothe. Ohio, recently sued 
for malpractice, has been acquitted. From the evi- 
dence given at the trial, it was proved that the case, 
which was one of fracture of the thigh, Avas skilfully, 
carefuU}', and conscientiously treated. Another case oi 
malpractice is in progress in that vicinity, but if the 
profession stand by each other as in this case, the re- 
sult can be easily anticipated. 

United States Marine Hospital Servick. — Jno. M. 
Woodworth, Supervising Surgeon U. S. Marine Hos- 
pital S^-rvice, Treasury Department, submits a com- 
parative statement of the operations of the United 
States Marine Hospital Service for the six months end- 
ing December 31, 1871, and the six months ending De- 
cember 31, 1870, showing the number of days of hos- 
pital relief and the amount of expenditures incurred for 
the care and treatment of sick and disabled seamen ; also 
the amount of hospital tax collected during the same 
periods. The reduction of the expenditures during the six 
months ending December 31, 1871, over the six months 



THE MEDICAL RECORD. 



95 



ending December ."il, 1870, amouiils in the aggregate 
to over $40,000, -which saves seventeen per cent, to 
the fund. Tlie amount of hospital tax collected during 
the last s-ix moullis uf 1871 is ten per cent, greater tlian 
the amount collected during the corresponding six 
months of 1870 under the opcra'ion of the same law. 

Alumni Association Medical Department of tiik 
Univeksity of New York. — The annual meeting of this 
Association was held at the Chai)el of the Collegiate 
Eeformcd Dutch Church, corner Fifth avenue and 
Twenty-ninth street, on Thursday evening, March 14th, 
1872. Dr. F. D. Lente, President, in the Chair. Tlie 
exercises were opened with prayer, by Pi'oC. Benjamin 
N. Martin, D.D., L.H.D., followed by appropriate intro- 
ductory remarks from Prof. Charles A. Budd, class of 
1852. Prof. D. B. St. John Roosa, class of 1860, then 
delivered an excellent and impressive address, in which 
the followingpoints were dwelt upon. That medical edu- 
cation is to be advanced through the medical colleges ; 
with three exceptions, the medical works published 
during the past year by a well-known publishing house, 
were written by professors of medical colleges ; and of 
ten papers read before the Medical Society of the Coun- 
ty of New York, during the same peiiod, six were by 
medical professors ; the Harvard Medical School, having 
raised the standard of medical teaching, should have 
the profession of New England at its back ; the Medical 
and Surgical Histories, written by Drs. Woodward, 
Otis, and others, under the direction of the Surgeon- 
General, cannot be suipassed by foreign autliors; the 
diseases of our day are of a more refined nature than 
those of a hundred years ago, and paralytic diseases, and 
those of the eyeball are on the increase — as shown by 
statistics; many of the teachers in our medical schools, 
who lecture on special topics, are not allowed to parti- 
cipate in the examination of students for a degree — ne- 
cessitating a radical change in the present system of 
medical teaching; in 1841, New York City had only 
one hundred medical students; now, in three schools, 
there are over one thousand endowments for professo- 
rial cliairs; libraries and scholarships are much needed; 
men who hold four or five hospital appointments, and 
are canditlatcs for more, should give up some of them 
to those wlio would be willing to give the profession 
the benefit of their experience. The relations of medi- 
cal men to the laity were fully discussed in the second 
part of the paper ; and an allusion was made to the un- 
wise decision of the governors of the late New York 
Hospital, in the removal of that time-honored Institu- 
lion from a section of the city where it was so much 
needed. He thought if the Medical Board of that hos- 
pital had an active part in the management of its affairs, 
it would have remained on its old site to this day. 

Following the acceptance of the paper and benedic- 
tion, !he following business was transacted : Drs. F. D. 
Lente, James R. Leaming, and James H. Anderson were 
appointed a Committee to investigate the charges made 
against the University in an article to appear in the 
Medical Record. The officers ibr 1872 are as follows : 
President, James R. Leaming, M.D. ; Vice-Presidents, 
Henry S. Hewit, M.D., Solomon S. Satehwell, M.D. of 
N. C, Charles A. Budd, M.D., Samuel M. Bemiss, M.D. 
of La., Wm. Canniff, M.D., of Canada, Theo. R. Varick, 
M.D., of N. J. ; Secretary, Charles Inslee Pardee, M.D. ; 
Treasurer, D. B. St. John Roosa, M.D. ; Orator, Solo- 
mon S. Satehwell, M.D. ; Executive Committee, Drs. 
James H. Anderson, Stephen J. Clarke, Francis V. 
White, F. Le Roy Satterlee, and Joseph T. Moneli. 

The Presbyterian Hospital, Phila.— At a meeting 
of the Trustees of this hospital, held Feb. 19th, the fol- 
lowing medical oflicers were elected •.— Consulting Sur- 



(jeons, Drs. Samuel D. Gross and D. Hays Agnew ; Con- 
sulting Physicians, Drs. J. L. Ludlow and Jacob M. Da 
Costa; Attending Surgeons, Dns. Thomas B. Reed, Os- 
car H. AUis, H. Lenox lloilge, and William G. Poiter; 
Attending Pltysicians, Drs. Edward Wallace;, S, Weir 
Mitchell, J. Forsyth Meit^s, and D. Flavel Woods ; Ob- 
stetricians, Drs. Robert M. Girvin and John S. Parry ; 
Ophtlialmic Surgeons, Drs. W. Wallace McCJme and 
(jeorge Strawbridge ; Pathologist, Dr. Dc Forest Wil- 
lard. 

The Dental Profession. — Oliver Wendell Holmes, 
M.D., in his address at the Commencement Exercises 
of the Dental Department in Harvard University, Feb. 
14th, after alluding to the fact that the teeth were par- 
ticular objects of attention in the time of the Egyptians, 
says that from the time of Galen to the middle of the 
seventeenth century, he has not found any other traces 
of a special dental profession until he came upon the 
following: Lr the Diary of the Rev. John Ward, Vicar 
of Stratford-on-Avon, from 1648 to 1679, are the^e 
lines: "Upponasigne about Fleet Bridg this is written, 
' Here lives Peter de la Roch and George Gollin, both 
which, and no other, are sworn opei'ators to the King's 
teeth.' " In 1820 there was not more than a hundred 
dentists in the United States. In 1858 there were 
4,000. Since then they have increased in as rapid a 
ratio. — Boston Med. and Surg. Journal. 

The Medical Department of the University of 
Pennsylvania, March 12th, graduated a class of eighty- 
three students. Thirty-four students received diplo- 
mas, Feb. 15ih, at the Commencement of the Massachu- 
setts Medical College. At the Commencement of the 
Medical Department of the University of Buffalo, held 
Feb. 20th, thirty-four students received the degree of 
Doctor in Medicine from the hands of the Chancellor, 
Hon. Millard Fillmore. The address to the graduates 
was delivered by Prof. James P. White. 

The Epidemic of Small-Pox in Chicago. — When the 
epidemic of small-pox commenced in Chicago, an order 
was passed that, after a certain date, none of those re- 
ceiving rations and aid from the Relief Society should 
have anymore food, clothing, coal, etc., without present- 
ing a certificate of vaccination, or of revaccination. This 
legislation, impossible elsewhere, and heretofore, over- 
came the objections of the ignorant against vaccination, 
and has served to stamp out the epidemic- One thou- 
sand persons were vaccinated daily for several Aveeks, 
the expense being borne by the Relief and Aid Society. 
The highest mortality from this disease in that city, 
according to the U. S. Med. and Surg. Journal, in any 
one week has been only sixteen. 

East River Medical Association, N. Y. — The fol- 
lowing officers were recently elected for the ensuing 
year : President, Dr. Henry E. Crampton ; First Vice- 
President, Dr. Daniel E. McSweeney; Second Vice-Pre- 
sident, Dr. Samuel Blume; Secretary, Dr. William J. 
Purcell ; Treasurer, Dr. Verannus Morse. 

Medical Electricity. — Dr. Roberts Bartholow, of 
Cin., contributes to the Clinic of Feb. 24th, with illus- 
trations, an instructive article on Medical Electricity 
and Medical Electrical Apparatus. 

Appointments. — Dr. A. 0. Kellogg, for nine years an 
Assistant Physician in the New York State Lunatic 
Asylum, has resigned, and accepted a like position in 
the Hudson River Hospital for the Insane ; Dr. J. M. 
Cleveland, Superintendent. Subsequently, Dr. Jud- 
son B. Andrews, Second Assistant Physician in the 
New York State Lunatic A-;ylum, was appointed first 



96 



THE mp:dical record. 



Aasistant; Dr. Walter Kerapster, third Assistant Phy- 
sician, wjis appointed second Assistant, and Dr. Daniel 
II. Kitchen, of New York city, was appointed third 
As-sistant I'hysician, to All the vacancy. — American 
Jo n rnal of In sa n itij . 

Medical B.\roxkt3. — Thirty-one physicians and 
thirteen surpeons have heen created baronets in Eng- 
land since 1<)45. Tlie first medical baronetcy, that of 
Sir E. Greaves in U»45, is disputed ; but of the si-cond, 
that of Sir Hans Sloane, practically the founder of the 
British >riiseum, there can be no doubt. 

Nkw YoitK Mkdico-IIistorical Socikty. — At tlie an- 
nual meeting of this flourishing organization, held re- 
cently, the following oflicers were elected for the en- 
suing year: — President, William T. White, M.D. ; Secre- 
tary and Treasurer, Zo\\n G. Frazer, M.D. ; Editor, Al- 
fred E. M. Purdy, M.D. ; Diarist, Bradford S. Thomp- 
son, M.D. 

Tiu: WiTtii-M.\NiA OK THK Sevkxtekntii Century. — 
Joseph Workman, M.D. {Am. Journ. of InsanHij). states 
that it has been calculated that from 1G03 to 1G80 the 
total put to death, by regular legal process alone, was 
about 70,000 ; and if, in the ten years of exclusion of 
the Stuarts from the tlirone, over 35,000 witches were 
destroyed, the annual number must have been over 
35,000, or nearly ten per day, Sundays not excluded. 

St. Vinxext's IIosimtal. — From the annual report of 
this Hospital, founded in 1849, it appears that 9G5 pa- 
tients Were treated during the past yeai-, of whom 53G 
Avere discharged cured, 185 improved, 49 unimproved, 
118 died, and 87 remain. In the surgical department, 
271 patients were operated on, of whom only 8 died. 

ALCOnoLic Spirits Conscmed ix the United States. 
— The cost of the clergy of the United States is esti- 
mated at $12,000,000 annually ; while that of criminals 
is §40,000,000, and of spirits $000,000,000. The re- 
searches of Otis Clapp, of Boston, Mass., in 18G9, give 
the loss to the productive power of this country, 
through intemperance, at from 10 to 20 per cent. At 
10 per cent, only, the loss on the agricultural and manu- 
facturing interests reaches the sum of $450,000,000. 
The census of 1870 will probably show this sum to be 
vastly increased, and perhaps doubled. 

Electricity in Diseases of the Skin. — Dr. George 
M. Beard, Xew York {American Journal of Syphihgra- 
phrj and Dermatology) says that it is yet too early to 
lay down special conclusions concerning the prognosis 
of different diseases of the skin under electrical treat- 
ment; but from what has already been accomplished, 
the general proposition seems to be justiliable. For 
many cases of psoriasis, eczema, anaesthesia, pityriasis, 
and prurigo, that under ordinary treatment are obsti- 
nate or incurable, electricity is of such great efficacy, 
both temporary and permanent, as to entitle it to a 
very high rank among the resources of the dermatolo- 
gist. 

A New Hospital for Animals has been opened in 
Dublin, known as the " Brown Institution." A large sum 
of money was bequeathed fur the purpose, in 1852, 
to the University of London. On llie Committee of 
Directors are Drs. Busk, Carpenter, Gull, Quinn, 
Sharpey, Sibson, and Simon. Dr. Burdon Sanderson, 
of University College, has been made professor. It is 
expected that the institution will add very much to our 
facilities for acquiring a knowledge of the action of 
remedies and the causes of disease. Although the 
laboratory is intended for research rather than instruc- 
tion, it will be open to all who wish to engage, on 



their own account, in scientific inquiries, providing they 
show evidences of previous scientific trainin;.', and pay 
their own expenses* 

Ai-coiioi.iSM. — Dr. Paluel de Marmon, of Kingsbridge, 
N. Y., in a rc^priiit from the Medicil World, discusses 
tlie " Medico-Legal Con8ideration.s upon Alioholism, and 
the Moral and Criminal Responsibility of Inebriates." 
He states that in ninety cases of a hundred, drunke-nnes 
is first contracted by imitation and politenes.s; for it is 
considered very impolite by some to refu-e to drink 
when invited so to do. Anotiier cause rests principal- 
ly in this country upon the bar-room system. Febru- 
ary 1. 1871, there were 7,0U0 dram-shops or hotels j»ay- 
ing license, under the Excise Law, in New York City, 
and, on the authority of an officer of the department, 
there was an equal number selhng without license, 
which would make 14,000 drinking places in New York 
alone — one for every Go inhabitants. The report of 
Messrs. Otis Clapp, John E. Tyler, and Wm. B. Spoon- 
er, made to the Lcgi.slaiure of Massachusetts, esti- 
mates that there arc 000,000 persons in the United 
States who have lost their power of self-control in the 
use of intoxicating liquors, and that in Massachusetts 
there are 23, (KM), of whicli number two per cent, die 
each year a drunkard's death. Dr. Marmon suggests 
the abrogation of the bar-room system as the best 
means to cut .short this human plague. 

Demonomania and WiTcricRAFT, — The.se subjects are 
pleasantly discussed by Joseph Workman, M.D., in a 
paper read before the Association of Medical Superin- 
tendents of Insane Hospitals, in Toronto, June, 1871, 
and published in the October No. of the American 
Journal of Inmnity. He says that it is not to be ex- 
pected that the foolish doctrine of belief in diabolic 
possession, which, less than two centuries ago, perva- 
ded the whole of Christendom, and was preachetl from 
every pulpit in our own and mother countiie-, and pro- 
claimed from every bench of justice, could utterly die 
out among the uncultured masses in any very short 
lapse of time. He has met with persons, not insane, 
who have avowed their belief in its present existence, 
and relates the case of a clergyman, who fled from the 
room where an insane woman was suffering from hj- 
cantliropia, and when he recovered his mental equili- 
brium, said " ! Doctor ! that woman is possessed ! " 

Customs and Salaries of Physicians before the 
Christian Era. — Boerhaave observes that before there 
were any professed physicians, it was the cus'.oni 
among the ancient Egyptians, when any one was sick, 
to inquire of neighbors and passengers if they knew ol' 
any proper remedies for the patient. But ever sine.- 
the study of physic became a profession, it has been 
both honorable and lucrative. The customary yearly 
salary which princes paid their physicians, about tht 
time of Christs birth, was 250 sestertia, or abov' 
2018/. sterling. Stertenius complained that he had 
only a salary of 5t)0 sestertia, or 4036Z. Os. 2d. sterling. " 
when Ke had by his private practice GOO sestertia, or 
4843/. 15s. — TJr. Arbuthnofs Book on Coin, and Mi-. 
William Smith's Book of Bemarks on the same Subject. 



Uctu publications. 



Books Received. 

Earth as a Topical Applicatiox ix Surgery. By 
Addixell Hewson, M.D., Attending Surgeon, Penn- 
sylvania Hospital, Phila. : Lindsay ifc Blackiston. 1873. 



THE MEDICAL RECORD. 



97 



Original Commumcations. 

THE MODERN OPERATION FOR STRA- 
BISMUS. 

Bv E. G. LORING, M.D., 

NEW YORK. 
RKAD BEFORE NEW YORK ACADEMY OP MEDICINE, MARCH 7, 1872. I 

It is with the hope of presenting to those of you wlio 
have not time to search through the various mon- j 
©graphs for more detailed information, a dight sketch 
of this important siilject as it stands at present among 
ophthiihnoloLtists, tliat I now offer these remarks, and I 
witli the hope of pointing out some of the most impor- 
tant considerations, both as to cause and effect, on a 
subject in regard lo which the general practitioner must 
oftentimes be consulted prior, if not in preference, to 
the ocul'st. 

In regard to the etiology of the complaint, it was 
ascertained by the labors of Bonders, and others, that 
strabismus occurred in 80 to 85 per cent, in hyperme- 
tropic eyes, or e3-e5 which were congenitally deficient 
in focalizing power. Without wishing to impugn 
this statement in tiie slightest degree, it has, neveithe- 
le?p, always struck me that an exaggerated importance 
has been given, not only by Bonders himself, but by 
all others, in regard to the share which the shortened 
antero-posterior axis really plays in the production of 
squint; for it must be borne in mind that emmetropia, 
or a perfectly normal eye, is a rather poetical condition, 
and trifling deviations from the normal standard, though 
sufficient to justify a classification of eyes in regard to 
refraction, cannot be sufficient to be the active cause of 
sirabismns. Thus it is hardly fair to suppose that a 
young child who has a strabismus of some 3 or 4 line?, 
and whose total deviation from the normal standard 
amounts to a convex glass of -'- or Ai, squints, because 
it i-5 unable to neutralize this very trifling defect by the 
action of the ciliary muscle. This attributing the pro- 
duciion of strabismus almost entirely to the existence 
of congenital far-sightedness, no matter how trifling it 
may be, has led Bonders and others to criticise some- 
what sharply, and somewhat unjustly, the statements 
made by general practitioners, backed up by those of 
nurses and mothers, that tlie squint in a given case 
had been caused by an attack of measles, whooping- 
cough, SL-arlet fever, or any of the thousand and one 
depressing maladies which are incident to childhood. 

Blinders has averred that if these cases are critically 
examined it will almost invariably be found that hyper- 
metropia is at the bottom of the evil ; and less renowned 
and less discriminating practitioners, following in his 
footsteps, have gravel}'', if not supercilionsl}^, waived 
away the convictions of the parent and family phy- 
sician, with the calm assurance that the child was 
born, if not with the fruits, at least with the seeds of 
the malady, and the cause t > which they attributed the 
evil had nothing to do with it. Now, I myself have 
frequently seen strabismus produced in children imme- 
diately after some sickness, when there was no error 
in the optical condition, and pass away again as soon a.s 
the strength of the patient was restored, from which 
1 have been forced to the conclusion, rather a self-evi- 
dent one. I admit, that wherever and from whatever 
cause the combined force of the ciliary muscle and in- 
terni recti is greater than that of the externi, there also 
strabismus is apt to occur; and that such a state of af- 
fairs will take place more Irecpiently in far-sighted eyes 
th in in others, follows as a matter of course. 



But the point which I wish to emphasize is, that a 
transient reduction in nervous foice, with over-exertion 
at su'.'li a time, may produce in emmetropic, or even in 
slightly myopic eyes, precisely the same factors favor- 
able to the production of strabismus Avhich exist through 
congenital structure in a hypermetropic eye. In other 
words, that such eyes, under the debilitating influences 
of disease, do become, practically speaking, lor the time 
being hypermetropic eyes, and are forced, from a reduc- 
tion in focalizing power, precisely like hypern.etropic 
eyes, to use a dispioportionately large amount of ac- 
commodation with moderate degrees of conveigence. 

So, too, a slightly hypermetropic eye, which, while 
t'lie general health was undisturbed, would never mani- 
fest the slightest tendency to turn in, may become, when 
reduced in strength, equivalent to one of great degree, 
with its accompanying tendency to become ciossed. 
And the practical lesson which I would draw from this 
is, that the general practitioner should be particularly 
on his guard not to permit his young patients, in tlie 
earlier days of convalescence, the indiscriminate use of 
their eyes, especially when confined to the bed, on 
books and toys and other occupations, which are often 
carried on with an intensity of purpose and an expendi- 
ture of nervous Ibrce, which, if applied in its weakened 
condition to any other organ, would end in its utter 
overthrow. 

The first step in the operation is to pick up the con- 
junctival and subjunctival tissue lying over the inser- 
tion of the tendon to be divided, which should be done 
with enough firmness to insure a not inconsiderable fold 
ol' the conjunctiva between the arms of the forceps ; for 
if this is not done, it will be found that Avhen the open- 
ing is made the scissors will glide beneath the conjunc- 
tiva alone; and th.e subconjunctival tissue, together 
with the extension of the capsule of Tenon, will have to 
be divided separately, which will necessitate a new hold 
with the forceps. Nor must the first incision with the 
scissors be, as is often recommended in the books, 
immediately at the corneal margin, but removed from 
it about a line and one-half, and just in front of the 
implantation of the tendon. This leaves a narrow 
line or bridge of conjunctival tissue still attached to 
the cornea, which is often of great service in the finish- 
ing of the operation, and which will be further dwelt 
on. 

But the principal difficulty, which is experienced by 
even those who have performed the operation repeat- 
edly, lies in the easy and successful passing of the hook 
Ijcneath the muscle so that the insertion shall be 
plainly exposed. And this difficulty is occasioned by a 
disregard of the anatomical distribution of the capsule 
of Tenon. This capsule, as you are aware, starts from 
the optic foramen, surrounds the optic nerve, and then, 
spreading out over the bulb, forms a cup-like cavity^ for 
tlie posterior half of the eye, in which the eye revolves. 
Anterior to the equator, however, the capsule is 
pierced by the muscles which pass directly through 
it, to be afterwards implanted in the sclera. At the 
place of perforation of the muscles the capsule of 
Tenon sends out reflections, which, joining with the 
connective-tissue sheaths, extend not only backwards 
towards the origin of the muscle, but also forwards to- 
wards the insertion where the capsule becomes mingled 
with the conjunctiva. In the anterior part of the eye 
adhesions also take place between the capsule and the 
sclera by the means of filamentous bands extending 
from the former to the latter. The effect of all this is 
to form, so far as the anterior part of the eye is con- 
cerned, a sort of sheath or sleeve in which the muscle 
is enclosed. 

Now the common way of making the opening 



98 



TIIK MKDK Al- RECORD. 



into the conjunctiva is to continue with the sciesors 
directly back in a lino with the belly of the muscle 
till it is juJgi'il that n suflioient openiii;,' is made; the 
hook is then inserted, and the operator is often sur- 
prised to find that, atU-r one or iwo attempL^, it does 
not plide beneath the tendon. Tlieopeninjj in the con- 
junctiva is enlarged, wiien a more determined effort is 
madt>, and it is Ibund thai this time, allhon<^'h the in- 
sirninent did not pass cleatdy as it s-iiould beneath tiic 
tendon, the point is covered by some portion of the 
niusi'le, which is hastily divided, and the operation 
is tinished as it began, in sncce-sivc attcmpt-f to fish up 
and divide the remaining attachments of tiie tendon. 
t)r it may be in another case that, after a liitle violence, 
something is felt to give way, and the hook then 
glides with the utmost ease beneath the nmsele, with- 
out the operator pausing to think what was tlie cause 
of the dilliculty in the first place, or the succc.-s in the 
latter. This was evidently due to the fact tliat the 
hook, in being rotated to pass behind the muscle, came 
in contact with the wall formed by the capsule, and 
either could go no farther, or, by carrying the capsule 
with it, proceeded far enough to just engage the muscle 
so as to hook it up by the centie, as it were, without 
fully passing behind it. Now the density of the capsule 
vanes in different cases, and sometimes with using a 
little force we are able to pusli the hook through it, and 
then of course it is plain ijailing. Sometimes, however, 
the capsule is so strong that the eye is carried before 
the hook and made to rotate in large circles in the or- 
bit, and the ditficulty of getting beneath the tendon is 
increased. 

I think, however, that all these difficulties can be 
almost invariably avoided if, after getting through the 
conjunctiva, ins;ead of dissecting directly backwards 
parallel with the belly of the nmsele, we carry the 
point of the scissors in a bold, free manner obliquely 
across the insertion of the tendon, almost at right angles 
to direction of the muscle, till we get into the loose tis- 
sue beyond ; by this little manoeuvre we make a small 
hole directly through the conjunctiva and subconjunc- 
tival tissue, and at the same time through the capsule 
and the processes which attach the muscle to the sclera. 
If then, on withdrawing the scissors, we gently raise the 
edge of the wound, the hook passes with the greatest 
ease beyond the horizontal edge of the muscle, and falls 
at once by the well-known movement of rotation 
directly beneath it, so that when the conjunctiva is 
gently drawn over the distal end of the hook the ten- 
don lies exposed for its entire length. This beinof 
the case, it only remains to divide it, and in doing this 
it is an essential point never to begin at that part of the 
hook which is nearest the shank, but at the distal end, 
and to gently raise the point of the hook as it is grad- 
ually dissected out, so as to prevent it from disengao^inf 
itself from the muscle till the tendon is thoroughly 
divided. 

It was formerly thought an advantage to make the 
opening in the conjunctiva as small as possible, and to 
make the section of the tendon as subconjunctival as ' 
circumstances would permit. But dividing the muscle ■ 
in this way is rather a tonr de force than any practical ' 
advantage, even if it could always be done with cer- ' 
tainty, which is by no means the case ; and then the 
original wound has to be enlarged. It is better to 
make a sufficient opening at the start, and to close it at 
the end of the operation by bringing the edges of the 
wound together in the most delicate manner with the 
finest possible silk, the ends of the suture being cut 
off as close to the knot as possible. The opening should 
not be greater, however, than two or two and a half 
lines. 'J'his gentle closure of the wound produces no ■ 



inflammatory reaction, and the suture comes away of 
itself, on aci'ount of its fineness, after a day or two, 
almost unperceived. 

We come now to the consideration of the later 
improvement.^, which are in themselvi s of a good deal 
of iiiifiortanoe, and often form, indeed, the principal 
features in the operation. Tlic.>^e are the means which 
Wf have in our power of increasing or diminishing the 
effect of the tenotomy. This is done by the use of 
8uture.«. 

We will take first the suture which is employed to 
increase the effect of the operation. The most effect- 
ual one of which I am aware is that which was first 
brought into general notice by Dr. Knapp a f w years 
ago, though it had been in use in this country for some 
time previous. The manner .ii which it is appied will 
be better understood by a diagram, which we will 
suppose represents a pair of eyes in which there is a 
very pronounced squint of the right eye. say of 5 or 
even G lines. We will suppose that the patient habi- 
tually squints with this eye, and that tlie excursion 
outw ards of this eye, though still good, is somewhat 
limited, and can only be obtained to a full extent by 
excessive convergence of the other eye. Under these 
circumstances we have good reason to believe that the 
exlernns, from being constantly on the stretch, has lost 
some of its elasticity, and will not, by forcibly re- 
tracting, draw the eye outwards after its antagoni.st 
lias been cut. We will suppose that the internus hiis 
been divided in the usual way, and that the effect from 
the causes just mentioned is very small, so small indeed 
that there is danger of the tendon reapplying itself at 
or very near the seat of its original implantation. It 
is manifest that we shall have gained little or nothing 
by the operation, and it is under these circumstances 
that the suture renders invaluable service. 

Dr. Knapp's description of the method is as fol- 
lows : — After a thorough tenotomy of the internus, a 
small fold of the conjunctiva of one or two lines is picked 
up close to the outer edge of the cornea, a curved needle 
armed with pearl silk is pushed through it, and the 
needle then carried through the external commissure 
from within outwards, and the cornea made to ap- 
proacli the outer angle of the eye to the required 
amount by drawing on the suture, which is then tied 
down upon the skin. By this means a fixed position 
is obtained for an eye which otherwise would have a 
tendency to turn in, during the time that the tendon is 
gaining its new attachment, whieh latter, ,is the eye 
is forcibly turned out, must lie further back than other- 
wise would be the case, and the effect is consequently 
much increa.sed. 

I generally seek to obtain about a line of diver- 
gence of the operated eye, immediately after the 
operation. The suture should be left in one or even 
two days. It very often comes away of itself on the 
second day, 

Graefe's method of increasing the effect of a teno- 
tomy is as follows : — After the tenotomy of the internus 
has been thoroughly performed, a fold of the conjunc- 
tiva is lifted off from the episcleral tissue with the 
forceps close to the outer canthus. A curved needle is 
then run horizontally throuL'h this fold into the 
subconjunctival space and made to glide (the forceps 
being removed to the upper and inner border of the 
cornea) beneath the membrane, till a portion of this 
equal to three, four, or five lines lias been included, 
when the point is again brought out, its place of exit 
varying according to the length of its subconjunctival 
passage, its direction being always from the commis- 
sure to the upper and inner corneal border, or it may 
be even to a point above the vertex of the cornea. 



THE MEDICAL RECORD. 



99 



The suture i-i then tightly drawn and tied. By tliis 
maiiceuvfe the eye is rolled outward.-; to the breadtli of 
the enclosed tissue, and the limitation in the move- 
ment of the eye inwards is much increased. In tliis 
way Graefe says one is enabled to obtain, in excessive 
degrees of convergent strabisinu-;, any correction de- 
sirable. The suture must be left in at least two and a 
half days. 

Tiie suture is employCLl in preci?ely the same manner 
in divergent strabismus, only it starts from the inner 
cinthtis near the caruncle. Graefe says that this 
method has been of signal service to him in the higher 
grades of strabismus, and that since its adoption lie 
has been far more reserved in the u^e of the advance- 
ment of the muscle. Indeed he asserts that he scarce- 
ly ever performs this latter now on account of diver- 
gence, but only on account of marked limitation of the 
mobility inwards. 

Such being tiie means by which the effect of a te- 
notomy is increased, those by wiiich the effect is 
diminished remain to be spoken of. This is still done 
by the use of the suture, and their mode of application 
will be made clearer, 1 think, upon the board. We will 
suppose that in a case of convergent squint we have 
already divided the internus, and that the effect ob- 
tained has been excessive, and that there is fear that 
the eye will go the other way, or at lenst there Avill be 
an insufficiency of converging power which may impair 
the use of the eyes for any length of time upon close 
object:*. Our object is to lessen the effect of the ori- 
ginal tenotomy, and this is done by the suture, the 
effect of which is graduated in the following ways : 
If we have reason to believe that the eflfect of the 
tenotomy is only a little more than that which we 
wished originally to obtain, we simply bring the edges 
of the wound together in a vertical direction ; this of 
course prevents the muscle from retracting as far as it 
otherwise would, and the effect of the operation is 
somewhat limited. We can increase this again by 
including more or less tissue within the stitch. 
If we want to limit it to a greater degree, then, instead 
of passing the needles vertically, we run them obliquel3' ; 
this of course draws the muscle still more forward, and 
the effect can be still further increased by including 
more of the conjunctiva and subconjunctiva tissue 
between the stitch. Or if, lastly, we wish to reduce 
the efifect to a ver}^ considerable decree, we then pass 
the needle in a directly horizontal direction, taking up 
more or le-s of the tissue, according to circumstances. 

It has been asserted with a good deal of force, 
especially by Von Graefe, that the controlling influence 
of these sutures is such that we can, if the operation 
has been skilfully performed, invariably get any effect 
whicii we may desire. While admitting to the fullest 
extent their great u.sefulneps, and the very important 
role they play in enabling us to increase and diminish 
in a general way the effect of a tenotomy, candor com- 
pels us to say that they have not in our own hands, 
nor can we understand from the very nature of things 
liow they can possibly act in anybody's with, that 
mithematieal precision which the great master has 
claimed for them. 

I know of no absolute rules which can be laid down 
as a guide either as to the immediate or permanent 
eff.-ct of a tenotomy ; still there are three things, a 
careful study of whicii should never be neglected. 
F.rst, the condition of the externi and the extent of 
motion outwards. Secondly, the refraction of the eye; 
and thirdly, the eSict of the accommodation. If, for 
example, the abduction of the eyes is limited, or only 
obtained by a vacillating motion as soon a.s. or shortly 
after, the squinting eye has passed the median Une, it , 



will be safe to predict that a greater setting back of ihe 
muscle will be requited, and the effect of the o|)cration 
will have to be increased by dividing both interni, — 
when under ordinary circumstances we should divide 
only one, — or, what is better, l)y the use of the suture. 
And we may be sure of this even after, the patient 
being thoroughly narcotized, we find, before we begin 
the operation, a divergence of the eyes. I have been 
so olten deceived by this amount of divergence wh< n 
patients are under the .influence of an ^anajsthetic, 
especially just after tlie muscle has been divided, that I 
pay no attention to it when I have once convinced 
my.vjelf that there is some weakness of the externi, 
but base my calculation entirely on the examinations 
made before the anajsthetic had been given — and this 
(.■specially in regard to the suture. 

Again we may put it down as a rule (but as a rule 
that has many exceptions), that the greater the amount 
of hyperraetropia, the greater amount of opeiating we 
may do without the lear of obtaining too great an 
effect. And here I Avould again insist upon the neces- 
sity of reducing the eye — before resorting to repeated 
operation — by the means of glasses, to as near a condi- 
tion of a normal eye as possit)le. 

Finally, if the eye swings in suddenly under the 
influence of the accommodation, so that the squint is 
disproportionately larger for the near than for the dis- 
tance, we may assume that the energy of the externi is 
reduced, and a greater freedom allowed in operating 
than when the reverse is the case; that is to say, where 
the squint neutralizes itself somewhat rapidly when we 
approach an object towards the eye, so that at mode- 
rate distances — twelve to sixteen inches — the two 
eyi'S seem to be directed to the object. Starting then 
with the assumption that in an ordinary ca=e of con- 
comitant squint we get from two to three lines as the 
efl'ect of an operation, the above rules may be of some 
service in some of the commoner deviations from the 
general run of cases. But for more than th's I should 
not like to be responsible. I would not w-ish by this to 
infer that I consider the operation of strabismus a work 
of chance, for I sincerely believe that the more fully 
w.' understand and the closer -we follow the optical and 
dynamical laws which govern the condition under 
consideration the more successful we shall be ; still I 
cannot yet believe, however hopeful I may be for the 
future, in that mathematical exactness which is at 
present often claimed for it. The only rule which can 
be conscientiously followed is to estimate by Careful 
study as closely as we can the probable result, and then 
to operate till success is obtained. 

Some eight or ten hours after the operation, or when 
the narcosis has passed entirely off, the patient should 
be seen again, when anotiier examination should be 
made, and this should be done as Graefe has shown, 
not, as is usually the case, directly in front of the pa- 
tient, that is, in the median line, but towards the tem- 
poral side of the eye which has been operated on, the 
object being at about fifteen feet from the patient and at 
about 15° towards tlie temporal side. This, of course, 
throws the strain off the divided muscle, and the in- 
sufficiency which follows as the immediate effect of the 
section is reduced, and a more correct estimate of what 
will be the permanent effect is arrived at. Thus, if the 
right internus has been divided, the patient should look 
to the right. 

I prefer, liowever, to make my examination in both 
places, that is, directly in front, and then towards the 
temporal side. As a rule, wdien, on seeing the patient, 
I find that less effect has been obtained than was esti- 
mated, I content myself with leaving things as they 
are, preferring to operate on the other eye, using the 



100 



THE MEDICAL RECORD. 



experience pained as to the eflect on the first eye as a 
fjuiiie to the st-cond operation. But wla'iiever my es- 
limatiim ol" the anla<;oiiistic force of tlie exteriii has 
been so much out of llie way tliat very Httle or no ef- 
Ici't has been produced, and the muscle is in danger of 
reattacliinp itself at or very near tlie place of its orijji- 
nal implantation, I never iiesitate to interfere ; and in 
tliis ciu<:e I always use the suture described by Dr. 
Kuapp, never that by Graefe — the eflect of which va- 
ries, as lie himself allows, in every case accordinpf to 
liie ditl'erent degrees of tlie elasticity of the coijuiutiva. 
If tlie patient is an adult, and posses-sca a moderate 
degree of nerve, an anieslhetic may be dispensed wi;h. 
The wound can be reopened and the new and yielding 
attachment*! reatlily severed with the strabismus hook. 
In children it is better to always use an anaesthetic. 

If, however, on the first visit after the opt-ration, 
there is good reason to fear that too much ellect has 
been obtained, the matter is much more serious, and 
should be remedied as soon as possible. It is, however, 
extremely ditficult to t,-ll, or at least to lay down any 
exact rules by which it can be sately judged that too 
much ellect has been obtained. Here it is that the 
expetienced eye has so great an advantage, for any one 
who has seen and studied a large number of cases can 
olten tell at a glance that too much has been gained, 
while it would puzzle liim to say exactly how he was 
aware of it. Still the following method of examination 
has been of service to me in a general way, and as 
such I now offer it: — 

If I find, twelve hours after the operation, that 
there is a line of divergence when the patient looks at 
an object, say at filteen feet, I look upon it not only as 
no detriment, but a positive advantage for the perma- 
nent eflect, provided the following conditions exist 
with it : that the object can be gradually approached 
towards the patient in the median line without the di- 
vergence in the operated eye increasisig to any percep- 
tible degree till the object gets inside of 12" or so. If, 
on the contrary, the divergence gradually increases, or 
even rema ns the same till within 10 or 12'' of the eye, 
and then the eye suddenly flies out, or even begins to 
waver, we have cause for apprehension, and the farther 
that such a condition takes place from the eye, the 
greater the dread. Acain, if we have a line or even 
more of divergence in the median line for the distance, 
and this disappears gradually as we carry the object 
towards the temporal side of the eye operated upon, 
till the" object lies 15' towards that side, we have Uttle 
diead that the eflect is excessive, especially if, as is usu- 
ally the case, the object can be carried close up to the 
eves without the operated eye yielding. 
" Should, however, the conditions of these two tests 
not be fulfilled, it would be on the safe side to limit the 
effect of the operations by the use of the suture, and 
the quantity of the limitation should be graduated by 
the degree of the divergence and the distance at which 
it takes place. The proper amount, or its approxima- 
tion, can, I think, only be learned by experience, to- 
gether with a careful consideration as to the efl'eets to 
be produced by the existing refraction and accommo- 
dation. 

The elal)orate rules laid down by Yon Graefe in re- 
gard to dynamic squint, or insufficiency, are not, of 
course, applicable here, as the requisite sharpness of 
binocular vision very rarely if ever exists to make such 
tests possible, much less trustworthy. The estimation 
must be made by the operator's eye, not by means of 
prisms. 

The indications for the operation for strabismus are 
rapidly becoming better known, so that many more 
cas'.s come to operation in early life than formerly. 



Still there is n lingering de>ire, especially on the part of 
general practitioncr.s, to advi-e the parents to wait and 
see if the child will not grow out of it, and to assert 
that cross eye often gels well of itself; and if it does 
not, it will be time enough to talk of an operation when 
the child has reached lU or 12 years of age. Now it is 
true that strabismus does sometimes disappear of itself, 
but it is an exceedingly rare occurrence ; so rare, indeed, 
a.s to be the exception neces.sary to prove the rule that 
it does not cure itself; and that in the vast majority ol 
eases recourse must be had to an operation. In regard 
to this there is no division of opinion. But in regard 
to the time of life at which the operation .should be per- 
formed there is, I am sorry to say, much less unanimity, 
and the general profes-ion have certainly the best of 
exeusL's for the Fabian policy which they reconnnend on 
the authority of some of the greatest writers on this 
subject. Thus Bonders advises the use of " atropine in 
young children upon whom it is as yet unadvisable to 
operate." And Stellwag deliberately says that " it ia 
better to postpone the operation till the beginning of 
puberty, if the strabismus be seen in chil ihooJ. By 
thus delaying, the conditions are fulfilled under which 
periodical straljismus is removed, and the patient may, 
as it were, grow out of a squint which has already be- 
come permanent." 

Notwithstanding the weight of such authority, I am 
decidedly of the opinion that the cases in which the 
operation should be deferred to a comparatively remote 
period are few in proportion to those that should be 
operated upon as soon as seen. And the chief points 
which .>^hoidd influence our decision, either pro or con, 
are as follows : — If the child is very young, say fiom 
one to three years, and the squint is concomitant, so 
that the excursion of the two eyes is equal, and at the 
same time the squint is bilateral, so that the child fixes 
sometimes with one eye and sometimes with the other, 
it will be safe to postpone the operation almost indefi- 
nitely, or so long as the conditions described hold good ; 
for under this state of affairs the normal mobility of the 
eye and the acuity of vision will be maintained ; and 
this rule should be observed ail the more if there is 
hypermetropia, for if this be of any considerable degree 
the squint will most likely return after the operation, as 
the age of the patient will prohibit the correction of the 
optical defect by glasses. 

But squint of this character is very rare in infants 
and young children, as it usually results, not from an 
optical defect, since the accommodation is not actively 
employed, but from some paresis of the muscle?, so 
that tlie squint is confined to one eye, and vision is 
either entirely performed by the other, or so seldom by 
the jqninting eye that this is practically excluded from 
the visual act. If such eyes are left, to themselves, two 
things almost invariably occur. 1st. The vision deteri- 
orates, so that the ej'e in a short time becomes useless. 
2d. The externus, from constantly being put upon the 
stretch, loses its vitality, and the mobility of the eye 
outwards is so reduced that the eye after a while gets 
the appearance of being, if I may so express myself, 
broadside on, producing, as the child grows up, a hide- 
ous deformity, and one Avhich later in life requires al- 
most an endless number of operations to remove. If, 
on the other hand, we operate early, when ttie weak- 
ened muscle still has a considerable share of its vitality 
left, we can do no possible harm, and we stand the 
chance of doing infinite good, either by cuiing the de- 
formity at once, or at least of turning what was a uni- 
lateral squint with exclusive use of one eye, into a 
bilateral squint Avith the alternate use of the two 
eyes, thus offering a much increased chance for the 
preservation of the vision, and a much better prospect 



THE MEDICAL RECORD. 



y 



4n 



01 <-^ 

A. 



of success from a future operation, when the muscles 
sliall liave more fully recovered their tone. In these 
cases it is almost always ncces>:ary to use the suture. 

between the ages of 4 and 6 we begin to get the 
common concomitant strabismus, dependent on either a 
congenital defect, that is, hypermetropia, or, what 
amounts lo the same thing, an imitation of this, through 
the tempiirary reduction of the accommodative power b}^ 
some debilitating disease. In this latter condition, tiiat 
i-, when the eye is emmetropic, or even slightly hyper- 
metropic, I never hesitate to operate, liistly, with the 
hope of restoring binocular vision ; and secondly, even 
if this fails, of removing the deformity ; for if this is once 
done there is little probability of its returning, since, as 
there is very little or no defect in the refraction, there 
is no exciting cause to occasion its return. After the 
age of 7 or 8 years I alwavs operate, and insist, if the 
error of refraction is sufiicient to warrant it, that glasses 
must be worn. 

Thus it will be seen, if these views are correct, that 
the latitude of operative interference is largely in- 
creased, at least in regard to the time of opeialing, in 
comparison with what is usually held to be sound prac- 
tice. 

There is one other condition of squint in which the 
general oi)inion seems to be adverse to operating, and 
that is the strabismus of a paralytic nature occurring in 
adults. This disinclination to operate in these cases evi- 
dently had its origin in two sound objections. First, 
an unwiUingness to subject the patient to the pain and 
annoyance of an operation when his strabismus is either 
accompanied by, or supposed to be the forerunner of, 
grave central trouble. Secondly, from a conviction that 
it was useless to operate on a muscle when the antan;- 
onist of that muscle was either partially or wholly 
paralyzed, as no effect would be gained. In regard to 
the first of these objections, it is no doubt true that any 
operative interference would be contra-indicated if cen- 
tral trouble was shown to exist; but there are very 
many cases in wdiich this does not manifest itself in the 
slightest degree, either at the time of the attack or 
later, or, even if it does in the beginning, fades away in 
a short time, while the strabismus, with its annoying di- 
plopia, remains. Under these conditions it seems to 
me that the indications for an operation are as strong, 
if not stronger, than in any other form of strabismus ; 
and that they are so, I think will be more foi cibl3^and 
more briefly shown by an example which is neither a 
rare nor an imaginary one. 

A man in the prime of life, after some exposure, or 
an unusually hard day's work, or even after the or- 
dinary routine of the day, goes to bed, as he thinks, 
perfectly well, and is astonished on waking up in the 
morning to find that he sees double. He immediately 
consults his family physician, who at once sees where 
the trouble lies, and, after a careful examination of his 
general condition, pronounces it sound, prescribes rest, 
absence from excitements and all abuses, whether of the 
spirit or the flesh, and gives iodide of potash in increas- 
ing doses. This maj^ or may not have some effect; 
usually it does not, and then all the changes are run? 
on the brom.ides, iodides, tonics, and electricity. Still 
the double vision persists, and what at first was a sim- 
ple annoyance now becomes an actual suflfering. There 
is a constant dragging sensation about that side of the 
head, with pain and tension in the forehead. The patient 
begins to have a difficulty in getting about, or even at 
times staggers or misses his footing. It is an exertion 
for him to think, and he begins to fear that he is get- 
ting light-headed, or that something is the matter with 
his brain ; and it is in vain that his physician or an ex- 
pert assures him to the contrary. To his suggestion. 



that, as his eye is turned, benefit might be obtained, 
from an operation, it is answered that, as his trouble is 
of a paralytic nature, it would be worse than useless; 
that things must be left to take their own course : and 
if this advice is taken, the diplopia generally fades away 
in a year or so, but the dragging, wearing, aching sen- 
sations in or about the eye usually remain, either as a 
constant companion, or to be called forth by the slight- 
est over-exertion or excitement. 

If, on the other hand, the patient, after a longer or 
shorter interval, seeks the advice of the trained ophthal- 
mologist, a minute examination is made, and I am 
afraid, as the usual thing, precisely the same advice is 
given, — exceptions to tiiis rul(>, though I am well 
aware they do exist, being few and far between. 
Sometimes, however, the oculist consulted, seeing that 
very little harm can result, boldly makes up his mind 
to run the chance of doing some good, and is often re- 
warded for his courage either by the cure or relief of 
his patient. 

The second objection, that we get no effect from the 
operation when the origin is a paralytic one, fades en- 
tirely away, since, by the use of the suture or by 
advancement of the muscle, we can get any effect we 
desire, no matter what the cause of the strabismus is. 

The treatment of paralytic strabismus is one of the 
most difficult problems that the ophthalmic surgeon has 
to deal with, and the dfterential diagnosis as to what 
muscles are aftected in a given case, as laid down in the 
books, and upon whicli we are made to believe our 
opinions should rest, is a thing which may well appal 
the boldest. So far as operating is concerned, the prac- 
tical considerations necessary to determine our opinion, 
at least in the majority of cases, can be reduced to a 
comparative few. In the first place, the oblique 
muscles, whether involved or not, are excluded, from the 
positions of their insertions, from the category, tenoto- 
ni}' of these muscles never having been, so far as I am 
aware, followed by successful results. Nor am I per- 
sonally aware of the attempt ever having been made to 
cut these tendons, though I have heard traditionary 
reports to that effect. This limits our attention to the 
four recti muscles, and in the great majority of the cases 
it is either the internus or externus which is chiefly af- 
fected, and oftener the former than the latter. When 
the superior and inferior are also implicated it is usually 
in a secondary degree, and the deviation a trifling one. 
When, then, a case of simple paralysis, either of the ex- 
ternus or internus, presents itself, I do not hesitate to 
operate, provided it is not marked by progressive dis- 
ease of central origin, and provided sufficient time has 
elapsed to show that therapeutical and hygienic means 
wid not remove the trouble. 

The only question, then, is, what operation we shall 
do ; advancement of the paralyzed muscle with a teno- 
tomy of the antagonist, or simply tenotomy of the op- 
posing muscle and the use of the suture ? This depends 
entirely on the degree of the trouble: if the paralysis 
is complete and the motion towards the median fine is 
very much limited, then resort must be had to advance- 
ment of the paralyzed muscle, as laid down in the books. 
But if the attack is slight, and rather a paresis than a 
paralysis, or a paralysis improved into paresis, and there 
is still some motion towards the median lino, then a 
simple tenotomy with the suture will often produce, as 
Graefe has pointed out, the most astonishing amount of 
effect. 

The fact of other muscles of the ocular group being 
affected, as for example the superior or inferior rectus, 
or even the obliques, used to be of great weight with 
me in determining the propriety of an operation, for it 
was argued that even if the horizontal double visicm 



102 



THE MEDICAL RECORD. 



was removed the vertical would remain, and the diplo- 
pia, tlioiifrh somewhal iliiTerent, would still be just as 
annoyiiijr to tlie patient. But cxpei ienc has sliown me 
that it is not ihe actual diplojiia whicli i:^ the ehii-f cause 
of trouhle and annoyance to tlu-se patients, hut the 
want of control they have over the eyes, and tlie subse- 
quent dia<jginp and achinpr sensations ; and this is partic- 
ularly noticeable when die strabismus is divergent. I 
should not, therefore, unless the complications were ex- 
tended and of a grave character, hesitate to operate to 
remove the lateral strabismus, and let the vertical diplo- 
pia take care of itself. I have known 15 or 20 degrees 
of this to disappear shortly aft'-r the lateral deviation had 
been corrected. But even if this cannot be corrected 
by a second operation or by prisms, the double images 
are usually sunk in the course of five or six n^onths, and 
the patient passes from an improved condition from the 
day of the operation, into what is ultimately a very 
comfortable one. 

As before remarked, very few of these cases come to 
operation, and the great mistake which usually lakes 
place in those that do, is that they are operated on too 
late, when secondary contraction of the antagonist has 
taken place and the weakened muscle has lost its vi- 
tality ; and then an advancement has to be performed, 
and not a tenotomy with the suture. 

A short time after the paralytic attack there is gener- 
ally an effort on the part of nature to re-establish the 
co-ordinating movements of the eyes, provided the cause 
is not a central one, and it is during this period that the 
operation should be performed; and although cases vary, 
and no rule can be laid down, it is usually best not to 
wait longer than two months after the original at- 
tack. 

I would say in conclusion, Mr. President, that I am 
rather unpleasantly conscious of the fact that the title 
of my paper has proved to be a misnomer, for instead 
of being, as I intended, a sketch of the operation for 
strabismus, as it stands at present, it is only an outline 
of a small part of it. Tliis has been caused by the vast- 
ness of my subject, which has compelled me to leave out 
mucli that I wished to write, and to discard much that I 
had already written. And as itis, I cannot help expressing 
the fear that my remarks have been both too extended 
and of too simple a nature for the dignity of the rostrum 
frdin which they have been delivered ; certainly they 
have for the critical acumen of many of my hearers. 
Still they are some of the points of practical importance 
over which I myself have thought a great deal; and I 
have believed that they might be of some use to those 
of you whose practice brings you in contact with many 
children, in answering the question so often put. Can 
>trabismus be cured ? — a question which, though facts 
do lend it some show of color, i.s, in the present advanced 
state of medical art, neither very comphmentary to the 
judgment of the general physician nor to the skill of the 
oph th almologist. 



Lead Poisonixg following the use of a " Hair Re- 
newer."' — A case of complete paralysis of the e.xtensor 
muscles of fingers and hands, with dropping of wrists, 
is mentioned by J. M. Crocker, M.D., Proviucetown, 
Mass., in the Boston Med. and Suvfj. Journal, produced 
by the use of a " hair renewer." the preparation con- 
sisted of three teaspoonfuls lac sulphur and two tea- 
spoonfuls sugar of lea 1 to a pint of water. With this 
he had drenched lii-; hair and sea!p as often as once a 
week for 15 years. Under the use of iodide of potas- 
siimi and galvanism the patient made a good recovery, 
the hair-dressing having been discontinued. 



CASES OF cs:rebro-spinal meningitis. 

Bv CHARLES W. PACKARD, M.D.. 

NEW TOBK. 

The following ca^es of Cerebro-Spinal Meningitis have 
come under my professional care during the past few 
weeks. 

Annie C, aged .seven weeks, was taken wi'h vomit- 
ing, restlessness, and fever at eleven p. m., on Saturday, 
February 24th. On the afternoon of the following day 
an eruption suddenly appeared, and the mother, beconi- 
ing alarmed, brought the patient to my office. 

I found the intiant collapsed, with a cool and pallid 
surface ; pulsa slow and somewhat irregular, pupils 
moderately dilated; and I learned that there had been 
slight diarrhd-a, but no convul.-ions. The eruption was 
roseolous in appearance, and ecchymotic. No diagnosis 
was arrived at, although it was very evident that some 
active blood-poison was at work. Difl'usible stimulants 
were at once given, but without avail, the case tern)i- 
nating fatally at one a.m. on the followinj; day, 26 
hours after the first symptoms of illness were noticed. 
Soon after death nearly the whole surface of the body 
became discolored, and of a hue varying from i)urple 
to dark-red. No autopsy. 

On the afternoon of the same day, on returning from 
the funeral of the infant, the parents found that their 
onh' remaining child, a healthy boy three years of age, 
was sick with headache, vomiting, and high lever. Ix. 
was hoped that these symptoms might depend on tlic 
fact that he had not slept the night before, owing to the 
commotion in the room caused by the preparations for 
the burial of the infant, and to his having eaten a large 
amount of indigestible food during the day. There was 
nothing di.scoverable in his physical condition that is 
not constantly met with in the ephemeral fever ot 
children. 

On the following morning, February 27tb, the mother 
called to inform me that he had passed a restless and 
feverish night (I have since learned that he had three 
undoubted convulsions), but that towards morning his 
bowels acted freely, when his fever left him and he 
slept quietly. On waking he seemed so playful and 
well that the further services of a physician were not 
considered necessary. 

^ 4 P.M., twenty-four hours after the inception of the 
disease, the father came in great haste to say, that after 
having been lively and apparently well all day, the 
child had suddenly met with " a change " and ap- 
peared to be dying. I found him collapsed and in.-en- 
sible, and apparently near death. The face and fore- 
head were pallid and absolutely cold. Temperature in 
axilla lul", pulse 84 and irregular, respiration 40 in 
the minute. Pupils somewhat dilated and variable. 
There were slight general convulsions at intervals of a 
few minutes. No abduction of thumbs or toes, nor 
rigidity of muscles; no eruption. Free stimulation 
was at once resorted to, and in the course of halt 
an hour a satisfactory reaction had begun. At this 
stage of the case I invited my friend Dr. Samuel Whitall 
to assist me in its observation and treatment. We at 
once catheterized the patient and obtained a specimen 
of urine which was normal in color and quantity and | 
contained no albumen. 

An eruption of petechial spots now suddenly ap- 
peared on the body and extremities, being most abun- 
dant on the neck and loins. The spots were of the 
size of flea-bites, though of darker color, and some were 
of a hnear shape, with fine radii upon one side, like the 
feathers on a quill. 

With returning warmth the nervous excitement be- 



THE MEDICAL RECORD. 



103 



came intense. There were frequent shudderings, and 
shiirt general convulsions, incoherence, witli occasional 
shrill outcrifS that he was fahiug. At times the de- 
lirium assumed a pleasant character for an instant, and 
the child would smile and utter short sentences, in an 
urgent, hurried way, such as "Mikey is a good boy," 
etc. ; there was persistent vomiting, and constant 
movement of the trunk and extremities. The expres- 
sion of the face indicated the e.vtreme gravity of the 
disorder. The brow was corrugated, the eyelids of a 
dusky red, looking just ready to become ecchymotic, 
the nose was pinched, and the upper lip drawn, and 
of a deathly pallor, in strong contrast to the brighter 
color of the cheeks. The movements of the body were 
unconstrained and natural, except that the head was 
slightly thrown back. 

In view of the almost maniacal condition of the 
patient, it was thought advisable to begin the adminis- 
tration of opium, which was given in increasing dose-^, 
beginning with one drop of the tincture every hour; 
the dose to be increased according to its effects. Hyd. 
sub. mnr. gr. x. was placed upon the tongue. The 
quieting effect of the opium soon became apparent. 
The restlessness subsided, and the convulsions became 
less and less frequent, and in two hours entirely ceased. 
The pulse became perfectly regular, but rapidly in- 
creased in frequency until in a few hours it had reached 
160. Respiration 42 in the minute. 

There was little change in the general condition of 
the patient for the ensuing twenty-four hours, the dose 
of tr. opii having been meanwhile gradually increased 
to five drops an hour; but at the end of the second day 
(forty-eight hours from attack) die violent and noisv ex- 
citement returned, and witli it the vomiting. There 
was subsultus and floccilation. The pupils were moder- 
ately contracted, but sensible to light; slight strabismus. 
No return of the convulsions. Xo new spots had ap- 
peared, though a part of the eruption was of a darker 
color than at first. The bowels had acted twice. 
Urine no'w slightly albuminous. The patient became 
comatose two hours before death, which took place 
sixty-one hours after the attack. 

An autopsy was made 30 hours after death, by Dr. 
AVhitall and mj^self Cadaveric rigidity well marked. 
On inspection the depending portions of the body were 
found slightly discolored, and the eruption had assumed 
a darker hue. Upon section the scalp was pale, and 
no blood followed the knife. Dura mater injected ; 
arachnoid intensely injected and dr}^ and underneath 
it an abundant effusion of recent lymph of a gelatinous 
consistency. This was found most noticeably along the 
veins of the vertex, the longitudinal fissure, the fissure 
of Sylvius, and there was also a slight deposit about 
the optic commissure. Tf.e vessels of the medulla were 
intensely injected, but no exudation had taken place. 
Cerebral tissue somewhat injected, but of normal consis- 
tency. Not more than 5j. of serum was found in the 
ventricles. The conditions under which the autopsy 
was secured rendered it impossible to extend the ex- 
amination to the spinal cord and its membranes. 

The following case occurred during my recent .ser- 
vice in St. Luke's Ho-pital. I am indebted to the resi- 
dent physician, Dr. Greo. D. Bleything, for the subjoined 
history and careful record of daily temperatures: — 

Annie Frazier, age 19, Eng., married, admitted 
January 27th, 1872. 

One week before admission was troubled with sore 
throat, pain in the head, and constipation. The day 
before admission had a severe chill lasting part of the 
r.ight, and followed by fever and vomiting. On enter- 
ing the hospital was suffering from .severe cephalalgia, 
and great tenderness and pain in the post cervical region. 

Some opisthotonos. There are large patches of her- 



pes about the mouth and on the left hand. The limbs 
are hypcrassthetic, but not swollen, and there is no im- 
pairment of motion. No tenderness in abdomen, no 
spnts on any part of body. The right eye seems slightly 
deflected from a right line, and there is ptosis of right 
lid. The tongue is vellow-coated, and the fauces red- 
dened. Pulse is full and frequent, and bowels costive. 
No abnormal sounds heard on auscultation. Is not at all 
emaciated. Temp. 104°. Ordered Sp. Minder., | ss. ; 
Sol. Magendie, git. vj. Jan. 28lh. — Slept well last 
night, but is suffering greatly this morning. The ce- 
phalalgia is increased, and tenderness of the muscles ia 
the post-cervical region is very marked. Opisthotonos 
more decided. There is some tenderness of muscles of 
trunk and limbs, but no paralysis. Water is passed 
without difficulty, bowels are costive, face is flushed, 
pulse dichrotic. Temp. 105°. Ordered Tr. aconite rad., 
gtt. iij. ; Sp. Minder., ? ss. every three hours; sherry, 
beef-tea, broth, and broken ice. Evening : More quiet, 
continued treatment, and ordered enema. Jan. 29th, 
symptoms continue with unabated force. Patient was 
very nois}' and somewhat delirious through the night; 
takes a fair amount of nourishment in fluid and semi- 
fluid form ; calls constantly for ice. Temp. 104*; pulse, 
130 and double. Stopped aconite, continued Sp. Mind, 
and stimulants. 

Jan. 30th. — Passed a bad night; was noisy and deli- 
rious ; applied ice to head, but could not keep it on ; 
vomited a green matter last night and this morning. 
Tem. 104|° ; ordered Tr. aconite rad., gtt. v. ; and to take 
Quin. sulph., gr. v.; Ac. sulph. dil., gtt. x., bis die; 
whiskey, § vj. ; sherry stopped ; beef-tea, chicken, and 
oyster broth ; egg beaten with sherry ; milk. Evening: 
Temp, 104° ; ordered Sp. terebinth., ? ss. in enema, and 
sinapism to back of neck. 

Jan. 31. — Mind is clear, and headache somewhat less; 
slept part of the night; still complains of the sub-occi- 
pital pain, and also of frontal headache. Temp. 103"; 
took last night Tr. aconite rad., gtt. vij. ; Sp. Mind., ? ss. 
every two hours ; stopped this morning and continued 
quin., etc. Evening : Temp. 102i° ; ordered Pulv. 
ipecac, cc, gr. x. 

Feb. 1. — Face is flushed, and complains that whiskey 
makes her head worse ; to be diminished to ? iv. 
daily; quinine with iron. Temp., a.m., 102.2; p.m., 102.2. 
Feb. 2. — Bowels have not moved sines last enema; 
tongue is a little broAvn at centre, and white over sur- 
face ; no spots or tenderness of abdomen ; no muscular 
tenderness or opisthotonos; has lain on right side al- 
most continually until now; this morning is lying on 
leftside; there is still drooping of right lid, and heavy 
I expression of face : slight impairment of hearing. 
Old. enema, containing ol. ricini, r ss. ; temp. 101°. 
I Evening, not so well ; complains of increased headache 
i and cardialgia ; coughs, and expectorates a bloody and 
I catarrhal matter, that apparently comes from posterior 
' nares. There is some redness of fauces. Temp., p.m., 
! 104.2. Pulse is full and rapid. Auscultation gives neg- 
ative results; stopped quin. and ordered sinapisms to 
epigastrium ; to take tr. aconite and sp. Minder, as before. 
Feb. 3. — Temp. 201.2. Is much better this morning; 
stopped aconite ; continue stimulants. Evening, increa,se 
of fever and headache. Temp. 106.2" ; renew aconite, 
enema to move bowels; sinapism to feet; ice to head. 
Feb. 4. — Temp., a.m. 



Feb. 5 
Feb. 6 
Feb. 7 
Feb. 8 
Feb. 9 
Feb. 10 
Feb. 11 
Feb. 12 



103°; 


P.M. 


105 


102.2 




105 


102 




104.2 


102 




104.2 


103.2 




104 


103 2 




104 


101.3 




105 


104 




105 


101 




104 



104 



THE MEDICAL RECORD. 



102^" ; 


P.M., 


lO.-j^^ 


98 


" 


1(15 


100 


(i 


104 


101 


II 


104 


104 


(1 


li4 


103 


11 


104 


OS 


II 


98 


93 


II 


93 



Tliis inoniinjj voiiiitdl bieakfust, nnd is cou^'liiiip and 
cxpecl oral ill},' oonsistuiit iiia-<.-i'«, resonibliiiR ralarrlial 
liischarg.s, sliglitly ninrkfil wiih blood. Fauces no 
lonj,'or leddciu'd, but pallid. 

Feb. 1.3. — Vomited again this morning; other 

symptoms are uncliangod, except that patimt had a 

jirofuse sweat this morning. TLniji., a.m., 103°; p.m., 

104°. 

Feb. 14— Temp., a.m , 102' 
11 15 

" IG " 

" 17 
II 18 

II 19 II 

" 20 

" 21 " 

Convalescence wa^ now fairly established, and the 
patient left tlie ho.-spital Feb. 2Gtli apparently well. Her 
appetite was good, and she slept soundly every night. 
Tliere was considerable emaciation and general weak- 
ness, such as would bo expected after so severe an ill- 
ness, but no perverted sensation or paralysis. 

Remarks. — The diagnosis of this ca-^e presented some 
points of difficulty. In many respects the symptoms re- 
sembled those met with in remittent fever occurring in 
a person of strong hysterical tendencies. Throughout 
the disease she had a tixed and placid expression of face, 
an<l looked as if she would get well. On the other 
hand, she had only one decided perspiration during her 
s'ckness. and quinine in large doses had no effect in 
checking the exacerbations of fever. For example, on 
February loth, the morning temperature had fallen to 
98' ; twenty grains of quinine were given and retained, 
and the evening temperature rose to 105°. On the 
following morning the temperature was 100° ; the 
quinine was repeated, and the evening temperature was 
104.^ 

After this no medication was attempted beyond the 
exhibition of an opiate at, night when the patient was 
very restless or delirious, the opium having been found 
to act more efficiently than any of the ordinary substi- 
tutes. 

The quieting effect of opium was still more marked in 
the case of the boy above leported. Here the tr. opii. was 
given in five-drop doses every hour, and its effects 
carefully watched. There is no doubt in my mind that 
lor twenty-four hours it so far steadied the nervous 
system as to stop the convulsion, and control the 
irregular action of the pupils and of the heart. Full 
n.ircotism was not produced at any time, the pupils 
being only moderately contracted, and the respiration 
never less than 30 in a minute. 

205 E. SOtli Street, X. Y. 



prooircss of illctiical Science. 



CULOROFORM IS THE TREATMENT OF BiLIART CaLCULI. 

— Dr. John Barclay, in a communication to the British 
MeAlical Journal, mentions the case of a man who had 
suffered for twenty-three years from gall-stones, and 
knowing that ethers are solvents of cholesterine, he pre- 
.scribed chloroform in doses of two or three drops three 
or four times a day, on the chance of reaching the 
calculi through the blood. The pain, tenderness, disten- 
tion, and jaundice, all disappeared together, and in the 
eight years which have since elapsed, the patient has 
never had another attack. 

AXTAGOSISM BETWEEN- CnLORAL AND CaLAB.\R BeAN. 

In five experiments on as many rabbits, fatal doses of 



the extract of ca'abar bean were injected hypodermi- 
eully alter the lull effects of chloral w^re produced, 
with a view to determine how far the poisonous inllu- 
encc of the former wa.s counteracted by the latb-r. In 
every case the convulsions were checked, and life pro- 
longed, but death ultimately resulted. 

Krperiinent G. Three-quarters of a grain of iho bean 
extract injected killed a fulI-;jrown rabbit, with violent 
general convulsions, in six minutes. 

Krpcriment 7. Kepeated in a similar rabbit, after fif- 
teen grains of chloral. No general convulsions, but 
death occurred in two hoiirs and fifty-three minutes. 

Krperiment 8. llepeated in a rabbit weighing si.x 
pounds, alter fifteen grains of chloral. No general con- 
vulsions, but in.senMbiliiy and profu.se salivation, paraly- 
.'■is, ;md nmscular twitchings; death in one hour and 
three-quarters. 

Ej-perime)it 9. Repeated in a rabliit weighing six 
pound-!. Same phenomena produced, lasting three and 
one-quarter hours, when tlie animal slowly recovered. 
Three-quarters of a grain of the extract of calabar bean 
would probably kill any rabbit in from six to eight 
minutes. The influence of chloral, in conteracting this 
result, was most marked, as wdl be seen by the experi- 
ments shown. — London Prartitioner. 

Sulphate of Ikon in Suppuration. — A child, burned 
all over, was lately brought into the hospital. The sup- 
puration from the wounds was soprofiise and offensive, 
that the ward, in which he lay, was almost uninhabita- 
ble. He was placed in a bath containing two handlul.s 
of sulphate of iron. The cessation of pain was almost 
immediate; after repeating the bath twice a day, for 
fifteen or twenty minutes at a time, the suppuration 
moderated, the fetid odor disappeared, and the patient 
rapidly recovered. — Boston Journal of C/iemistri/. 

Arsenic in Dyspepsia. — Dr. J. C. Thorowgood, in 
the Practitioner, speaks highly of the action of arsenic 
in many diseases of the stomach. He has found that one- 
drop doses of Fowler's solution inhalf an ounce of infu- 
sion of Columba had the effect, in a case he treated, of 
allaying the pain, stopping the vomiting of food, and 
enabling the patient to eat and digest small quantities 
of nmtton. lie states that the small irritable tongue, 
with projecting papillie and yellow or gray fur, indicate 
arsenic. The more purely local the gastric .symptoms, 
the better is the chance of arsenic doing good. Where 
there is much general exhaustion of the system, with 
disordered urine or hepatic congestion, it does not 
promise much. 

New Treatment of HYnROOELE. — The Gazette Ilthio- 
madaire contains a paper prepared by M. Monod, de- 
scribing his method of treatincr hydrocele and other 
serous accumulations, by injecting alcohol, either pure 
or diluted. He first makes a puncture and draws off t 
a drachm or more of the fluid, and then injects the' 
alcohol. The operation is repeated, if necessary. By : 
this method he succeeded in curing three cases of hy- j 
drocele, and a serous cy.st of the neck resembling goitre, 
the injection of a small quantity of a'cohol cau.-ing a I 
rapid absorption of the entire fluid without inflamma- 
tion and without requiring the patients to remain in | 
bed. He suggests the same method for other serous | 
accumulations. — Pacific Medical and Surgical Journal. 

Dislocation and Fracture of Femur. — Dr. J. R. 
Weist {Indiana Journal of Medicine) I'eports a case of 
dislocation of the head of^ the femur upon the dorsum 
ilii, in a lady fifty-seven j'ears of age, in Avhich he at- 
tempted the reduction six months alter the injury. In 



THE MEDICAL RECOHD. 



105 



the effort at reduction by manipulation, the neck of 
the fi'inur was IVacturcd near the shnl't. The limb was 
easiljr broii<rlit down on alino with the other, and when 
left to itself wr.s only shortened from a half to throe 
quarters of an inch. Q'he patient was placed in bed, and 
tension made for six weeks by means of pulley, weight'*, 
and adhesive straps. At the end of this time union 
seemed to be suOiciently firm, and all dressings were 
removed, and daily motion of tlie joint kept up. After 
walking, shortening increased iVom a quarter of an inch 
to an incli and a quarter. A year after the patient 
could walk quite well without the aid of even a cane. 
Nearly all the natural motions of the limb could be 
executed external rotation and abduction being most 
restricted. Tlie head of the femur remained in about the 
position it was before the fracture. 

SuLpnuRous Acid in SvPHrLiTic Ulceration. — Dr. 
jSIurchison has recently tested this remedy at the Mid- 
dlesex Hospital, with a favorable result, in the case of 
an old woman, with tertiary syphilitic ulceration of the 
pharynx, involving deeply the posterior pillars of the 
fauces. Iodide of potassium with chlorate of potash 
was employed internally, and the sulphurous acid (one 
part to four of water) was used locally in the form of 
spray. The ulceration was speedily checked, and con- 
tinued to improve so long as the application was kept 
up. When the treatment was omitted the ulceration 
recommenced. — Richmond and Louisville Med. Jourivd. 

Chloral Hydrate in Trismus Nascentium. — Dr. F. 
Auchentha'er relates a case of trismus nascentium oc- 
curring in a patient seven days old, and treated by chlo- 
ral hydi-ate in doses of grs. vj. dissolved in mother's 
milk. During the convulsions the medicine was carefully 
instilled through the nostrils. Immediate benefit was 
noticed, and in nine days the disease had entirely disap- 
peared. During that time the child had experienced 
twenty-seven paroxysms, and had taken twenty-five 
grains of chloral. The temperature of the child's body, 
duriufy the convulsion^, was seldom increased, and at 
one time rose beyond 70^ C. — American Jvuriud of 
Medical Sciences. 

An Astringent in Gleet. — Dr. R. S. Johnson extols, 
for cure of gleet, an astringent injection composed 
of: IJ. Tr. opii, 3j. ; Tr. citechu, 3ss.; Mist, acacire, 
3 ij. ; to be used twice daily. He relates one ca«e in 
Nvhich the discharge ceased after the second application, 
and did not return. — Medical Press and Circular. 

On Simple Dislocation of the Os Innominata. — Mr. 
C. Holthouse, of Westminster Hospital (The Prarfi- 
tioner). reports two cases of this nature, which he has 
recently met with in his practice, and gives the notes of 
the only other cases, five in all, which had been previ- 
ously published by other surgeons, in only three or four 
of which had 'the injury been diagnosticated during the 
life of the patient. Of the cases narrated, including liis 
own, two were cnused by falls from a height, one by 
heavy weights falling on the front of the pelvis, two 
by pressure.'and tAVO by blows. In most of them the 
displacement was upwards and backwards. 

The only accidents with which this injury is likely to 
be confounded are fractures of the pelvis, and of the cer- 
vix femoris. The method of measuring the degree of 
shortening from the iliac spine to the lower border of 
the patella will exclude the latter ; the true character of 
the injury being indicated by the mobility of one side of 
the pelvis, and the absence of true bony crepitus. Five 
of the cases reported recovered with more or less l.nming. 
Mr. Holthouse considers a favorable prognosis warrant- 
able, especially in the case of a young subject and when 



uncomplicated. There seemed to be no reason why, 
with moderate extension, manipulation, and a su'^taining 
bandage, these cases might not have rccovcj-ed with 
very little deformity. 

Iodide of Starch Poultice for Slouohing Ulcers, 
ETC. — Take two ounces of starch and mix with six 
ounces of boiling water, to form a jelly ; then add, before 
cold, half an ounce of tincture of iodine. The poultice 
is now ready for use. 

Modification of the Ordinary Tests for Biliary 
Acids. — M. Strassburg, of Bremen, suggests a modifica- 
tion of Pettenkofer's test for the presence of the bihary 
acids in urine, which promises to be serviceable clinic- 
ally, and, according to his statements, is of extreme 
delicacy, enabling a trace not exceeding yin^noTT to be 
readily detected. He dips a slip of filtering paper into 
tlie urine suspected to contain the biliary acids, and to 
which a little cane sugar has been previously added. 
The slip is withdrawn and dried; a drop of pure, con- 
centrated sulphuric acid is now applied to it by mean.s 
of a glass rod. On holding the paper up to a strong 
lidit, a beautiful violet color makes its appearance. — 
Fiiiger's Archiv. The Practitioner. 

A New Sedative. — Prof. Deneffe, of Ghent, states 
that for more than two years he has employed a combi- 
nation of camphor and bromine, which he thinks enti- 
tled to general attention. The celebrated chemist Lau- 
rent showed that bromine will easily unite with cam- 
phor at ordinary temperatures, but that the product is 
slowly decomposed by exposure to air. Prof. Schwartz, 
of Ghent, has shown that this substance, being heated 
in a closed vessel, is resolved into hydrobromic acid and 
a crystallized compound, differing only from ordinary 
camphor by the substitution of an atom of bromine for 
an atom of hydrogen. This substance is perfectly crys- 
tallizable, fusible at 7G^ C, and boiling at 274". In- 
vestigation of the therapeutical properties of the drug 
has shown it to be an excellent nervous sedative. Prof. 
DenefFe publishes a case of excitement of the nervous 
system, which was effectually relieved by it; seventy 
grains may be made into thirty pills, of which one is 
a dose, and may be repeated every hour, if occasion 
requires. — Times and Gazette. 

ScuRVY.^In the report in the Archives Generales de 
Medecine, by Drs. Ch. Las^gue and A. Legroux, of the 
epidemic of scurvy which took place in the prisons of 
the Seine and the Hupital de la Pitie, in September, 1870 
(during the siege), the curious fact is noted that in the 
eighty-three cases which fell under their observation, 
none of the patients were females, although the condi- 
tions of privation were the same in the cases of both 
sexes. 

The Oxalate of Potash, in the treatment of perito- 
nitis, is recommended in the Jour, de Med. et de C'hir., 
small doses in mucilage, repeated every hour, having 
produced good results in three cases of puerperal origin. 

Quinine and Digitalis in Hemicrania. — The same 
journal states that i\IM. Df'bout and Gauchet have ob- 
tained good results from this combination of remedies 
in the treatment of vugraine, the formula employed 
being, sulphate of quinine forty-six grains, powdeied di- 
gitalis twenty-two grains, of syrup q. s., to be made into 
thirty pills, of which one may be taken every evening. 
Attacks connected with the menstrual period .«eem to 
be most easily controlled by it. — The Practitioner. 

Puncturation in the Treatment of Strangulated 
Herma is spoken of by Dr. Autun, in the Gazette des 
Hopitaux, several cases being mentioned by him in 



106 



THE MEDICAL RECORD. 



which tin' cxtrnct ion of pas and air by the opernlion 
rendetvd the rt-diiclion ol the hernia pns^ible. No bad 
results occurred. 

IlYDRorm.onATK of Amorphia. — The Ediuhnrg Medi- 
cal Jourual tukcs from thi' Berliner Kliuisrhe Woclten- 
schri/t the following dcsciiption uf a drnj,' about which 
but iiltle is generally known. Sitbcrt, Ricgel, and 
Bohmo have a.«certainp(i, by numerous experiments on 
man and animals, that it is an ell'ectiial and active eme- 
tic, aclinj:, aceordiiig to liohnie, in from four tosi.xteen 
minutes, leaving behind it no unplea-ant efl'eets, and 
possessing tlie important quidily that it can be cflectual- 
ly introduced siiboutaneou.'^ly — a niatter of importance 
in cliildren, insane, and comatose patient-J. Tlie unplea- 
sant eflects have occasion:dly been giddines-!, cerebral 
oppression, tendency to yawn, and precordial anxiety ; 
and even tliese disappeared with the occurrence ol" 
vomiting. No disagreable results on the digestive 
organs were ever observed, and suppuration never took 
place at tlie point of injection. The pliysiological effects 
upon the pulse, temperature, and blood-pressure, were 
found by Siebert to be of no practical importance. The 
quantity necessary to produce emesis in man, when 
u;:ed hypodermicaily, is 0.0925 to O.lOS gr. The mo.st 
reliable pie[)aration is said by these observers to be 
that of Macfarlau & Co., of Edinburg. 

Similarity in the Clinical Appearancf:s of Ovari- 
tis AND Typhoid Fever. — A writer in The Lancet of 
February 24th .speaks of a case of the former afTection 
under the care of Dr. Ramskill, in the London Hospital, 
in which, for twenty days, tiiere had been a tempera- 
ture ranging between 90.5' and 105'. There had, also, 
been considerable dulness of intellect during tliis pe- 
riod, together with marked tenderness in the x'v^hi iliac 
region and consi-derable diarrhoea, the stools being very 
like those characteristic of typhoid fever. 

Ligation of the External Iliac Artery, high up in 
the rigiit side, has recently been performed by Dr. 
Butcher, of Dublin, in a man sixty-eight years old. 
Thirty-five days after the operation the ligatures came 
away, and b}' a fortnight later the wound was quite 
healed, and the temperature and sensibility of tlie limb 
restored, the aneurismal tumor having been reduced to 
about the size of a billiard-ball, and become quite firm 
and hard. The time occupied in the opei ation was nine 
minutes, and the necessity for its performance was the 
jires..'nce of an inguinal aneui ism, which was so large as 
to extend above Poupart's ligament. 

LiEBREicn ON Chloral Hydrate. — In the Gazette 
Hehdumadaire for Dec. is an article by Prof. Liebreich. 
in which the conditions of the use of chloral are laid 
down more definitely than they have been heretofore. 
All cases of insomnia without fever form the basisof its 
application. For the relief of severe pain it cannot be 
depended en without the addition of opiates. The 
contraindications pointed out by Liebreich are as fol- 
lows : — 

\. Extended destruction of the mucous surfaces of the 
prima vice. Here the remedy, if used, must be much 
diluted with mucilage ; or it maybe thrown into the 
rectum. 

2. Arthritic conditions are unfavorable, unless the 
blood be first rendered alkaline. 

3. In tvphns, if given, it should be in small dose?. 

4. In aflections of the circulatory apparatus, espe- 
cially valvular and other serious troubles of the heart, 
small doses should be used. 

5. It is contraindicated in hysteria, in which it 



often inerea.«e.H and fixes the condition of excitement, 
whirh Prof. Liebreich considers inexpliealtle. 

(i. Whether or not it is contraindiealed in icterus 
remains doubtful, it having been so a.sserted. 

The author goes on to say that it hhould never be 
given in sulislanoe, nor in solution stronger than twenty 
parts to a hundred. 

It may be mixed with beer, wine, beef-tea, and mu- 
cilage, lie prefers syrup of orange-peel. The so-called 
syrups of chloral hydrate are solutions in glycerine with 
sugar. Thin gruel may be employed ss a vehicle for an 
enema. In certain convulsive attacks it may be applied 
hypodermicaily. The cigarettes which have been pro- 
posed are inadmissable. The best do.se for an adult is 
irom thirty to forty-five grains. Habitual use does not 
require increase of dose. "Long-continued use does 
not impair the general health. I know persons who 
have taken it almost since its introductiim, in the same 
dose, and with the same success." — The Doctor. 

[Dr. Squibb, of Brooklyn, .«ays thats<dutionsof chloral 
hydrate with .syrup undergo decompo-it on int >, as yet, 
unknown substances which are as likely to be poison- 
ous as benign, and advises that if mixed with syrup it 
should only be for immediate use. Cases have been 
observed in which the loni,'-continued use of the reme- 
dy has oicasioncd. it is thought, pains resembling those 
of arthritic origin.] 

Local Treat.ment of thk L'teru.s. — R, A, QuarlcF, 
M.D., of St. Louis, Mo. (St. Louis Med. and Surf/. 
Journal), in his Annual Report of the St. Louis Insti- 
tute for the Tieatment of Diseases of Women, mentions 
tliat tincture of iodine Cgr. 90 to Jj.) has been in almost 
constant use in treating hypertrophies, chronic en- 
gorgements, ca'arrhs and inflammations of the womb 
and its lining membrane. Erosions of the os have 
yielded most readily to a strong solution of nitrate of 
silver. In almo.st all cases of uterine disease, warm 
water vaginal injections were employed, medicated or 
not, as the individual case required. For all cases of 
vaginitis, whether specific or not, balsamum copaiba; 
fnjection proved an unfailing remedy. 

Thapsia as a Rubefacient and Revuisive. — The 
action of this plant (one of the umbellifene) is very per- 
sistent, differing, in this respect, from the ordinary rube- 
facients. It may, therefore, be regarded not merely as 
an accessory therapeutic agent, but as an independent 
remedy to be used with advantage in many affection.': 
of the vascular and nervous systems associated with 
painful hyperassthesia. which it .«eems to remove in a 
very noticeable manner. Dr. Armand has found its use 
of preat service in inflammatory disea.ses of the chest 
and of the larynx, when, in the latter, there was a con- 
siderable amount of piping and whistling in respiration, 
and great sensitiveness of the surface; and equally val- 
uable in angina faucium. It may be used for children 
as well as adult;. — AUgem. Wiener Med. Zeitung. 

Pei-iosis Rheumatica. — Dr. W. A, Hardway, of St 
Louis, Mo. (St. Louis Med. and Surg. Journ.), presents 
a case of this quite uncommon affection, occurring in a 
lad of 16, which exhibited features in common with 
ordinary rheumatism, and might be taken for a case ol 
that nature, the eiuption having been regarded as of 
incidental occurrence. The fact, however, of the pete- 
chias and the rheumatic pains being nearly always 
coincident events, the absence of the elevated temper- 
ature and more rapid pulse of acute rheumatism, to- 
gether with the subsequent course of the disease, 
clearly pointed out the distinction. Again, from the 
J general malaise, the eruption, the pain.=;, peliosis rheu- 



THE MEDICAL RECORD. 



107 



matica might be mistaken for an early syphilitic mani- 
festation ; but the absoneo, after careful examination, 
of any primary lesion, and of a venereal history, -would 
settle tlie question satisfactorily. 

TriK T'sis OF Pus in the x\nimal Economy. — Dr. A 
P. Reid, of Halifax {Canmln Me'l JnnrnaJ), writes, in 
regard to the use of jius in the anin:al economy, as fol- 
lows : — 

1st. It is the method by which dead exudation cor- 
puscles and fluids assume a condition allowing of their 
subsequent removal by a channel which is not ne- 
cessarily injurious to the system at large, as they 
would be if permitted to enter the blood, to be ex- 
pelled by the enumctories. 

2d. It is the method by whicli the before-mentioned 
matters so collected together, when, from tavoring cir- 
cumstances, tiiey cease to produce irritation in their 
vicinity, are absorbed or removed by the emunctories; 
the solid parts 6rst having undergone a fatty trans- 
formation, owing to the influence exerted on them 
by the free circulation of blood in the walls of the 
ab-cess. 

3d. It is the method by which dead exudatioh ma- 
terial finally becomes incapsulated. The abscess ceas- 
ing to produce inflammation in its vicinity, the free cir- 
culation of blood in tlie abscess wall exerts such 
changes in the composition of the fluid parts of the 
pus as permit of their absorption without injury to 
the health of the solid part, which cannot be so dealt 
with, and which becomes inspissated in the form of in- 
nocuous substances, such as f\it, phosphate of Ume, car- 
bonate of lime, and other salts, united by an indeter- 
minate animal matter. 

4th. It is the method by which tissues of all kinds, 
when deprived of their vitality, are reduced to a fluid 
capable of easy removal ; as the contents of an abscess. 

5th. It is the method adopted by Nature to assist 
vital absorption in amputating dead tissues, either ex- 
ternally or internally. 

6th. It is the method which assists ulcerative absorp- 
tion, so termed, in bringing an abscess to the surface; 
one portion or side of the abscess wall becoming grad- 
ually thinner as the abscess points. 

Chloride of Zinc with Chloride of Potassium. — Or- 
rlinary chloride of zinc is unsatisfactory as an escharotic, 
because of its hygroscopic tendency." M. Bruns (phar- 
macist) states this defect may be overcome by fusing 
two parts of the chloride of zinc with one of the chlo- 
ride of potassium, and casting in sticks which are to 
be wrapped in tin foil. 

Forced Delivery. — T. A. McKinney, M.D. (Leav. 
Medical Herald), communicates an interesting case of 
puerperal convulsions, with attending pneumonia, 
showing the following points of interest: 1st. Forced 
delivery is not unfrequently the only remedy for puer- 
peral convul>ions. 2d. Delivery may be undertaken 
after the seventh month without danger, when the os 
is but very little dilated, though there may be no 
signs of labor near. 3d. Pneumonia, caused possibly 
by a poisoned state of the blood, may be a complication 
of puerperal convulsions, though not always a fatal 
one. 

Treatment of Blennorrhagia. — Eleven cases of 
blennorhagia are related by J. C. Van Wyck, M.D., of 
Oakland, Cal. ( Western Lancet), in which treatment by 
carbolic aciil, in combination with astringents and I 
anodynes, was, he states, as near being a specific in 
uncomplicated cases as any remedy believed to be 
such in the domain of the materia medica. So firmly , 



is he convinced that to it alone are to be attributed the 
gratifying results which have marked every case in 
which it was employed, that with the next patient who 
comes under his care he will use the remedy simply 
diluted with distilled water. 

The Use of Alcohol in Chronic OtorrhovA. — A. "W. 
Calhoun, M.D., now of Berlin, Prussia ( fi^eorr/Za ^[ed. 
Comp.), having been sceptical in regard to the benefi- 
cial use of puie undiluted alcohol for the cure of un- 
complicated chronic purulent otitis, or otorrhoea, as 
practised in the clinic of Dr. Weber, one of the editors 
of the Monatschrift fur (jlirenheilkunde, writes that he 
has been enabled to follow a number of cases, as they 
progressed under this treatment, from the date of 
their first entrance into the Clinic till their dis- 
charge as cured — and is now thoroughly satisfied of 
its eflicacy, having seen cases of eight and ten years' 
standing, with destruction of membrana tympani, cured 
in comparatively short time. The application of undi- 
luted alcohol does not produce intense pain ; for a few 
moments there is a smarting, slightly burning feeling, 
which gives place to a sensation described by patients 
as that of an " agreeable warmth." This latter lasts 
for a considerable time. 

T^NiA Solium and Taenia Lata in a Child Three 
Years Old. — A case of this character, occurring in a boy 
three years and four months old, is reported by Dr. 
Joseph Ganghofer, in the Kansas City Medical Journal. 
The child had excessive craving for carrots, of Avhich 
he would daily consume large quantities, both cooked 
and raw. After persisting in this unnatural appetite 
for six weeks, a toenia solium of about eleven feet in 
length was passed. The morbid appetite of the patient 
still continued, and, on account of the largely distended 
abdomen, the carrot treatment was advised. Within 
two weeks another worm was passed ; this time a 
tccnia lata ten feet long, which came away entire, in- 
clusive of the head. 

Dr. Ganghofer remarks that the use of carrots as a 
domestic anthelmintic in cases of ascarides and lum- 
brici is no novelty, but their eiBcacy in dislodging the 
diflerent varieties of tape-worm has never before been 
established. It would appear that the large amount of 
saccharine matter contained in the vegetable must have 
sickened the parasite, and thus have caused its detach- 
ment from the walls of the intestine. 

Treatjient of Cystitis and Irritable Bladder of 
Females.— M. Yarnall, M.D., St. Louis, Mo. (The Med. 
Archives), calls attention to a treatment for cystitis and 
irritable bladder of females, practised by Dr. T. L. 
Papin, which has afforded such excellent results. This 
treatment, which is original with Dr. Papin, consists 
in dilating tlie urethra with a long pair of dressing 
forceps to such an extent as to produce temporary in- 
continence of urine by rupturing a few of the fibres of 
the sphincter of the bladder ; and repeating the operation, 
when necessary, at intervals of a week or more, until the 
patient is completely relieved. In nearly every in- 
stance the relief afforded is almost immediate, but in 
the course of a few days the irritabihty of the bladder 
ussually returns, M'hen the operation has to be repeated, 
and, if necessary, again repeated, until a cure is ac- 
complished. 

The operation being at first very painful, it will usu- 
ally be found necessary, in performing it the first time, 
to place the patient under the influence of an anaes- 
thetic; but its subsequent performance being much less 
severe, as a rule, the anaesthetic will be unnecessary 
unless the patient be of a very nervous temperament. 
Of the twenty cases thus far treated, eleven have been 



108 



THE MEDICAL RECORD. 



entirely relieveJ, nml eight, still umler Ireatinent, have 
been bcnolited, •vvitli a pro-pect of pcriiiftiient relief. In 
onlv one case has it failed, a very hysti-rieal individual 
addicted to the excessive use of nareotfics, and with 
whom the trouble oiipinatcd, piobably, in the over- 
wroujijlit mental condition of the patient rather than 
the ve.-ical irritation; and even here the patient was 
unquestionably benefited. 

Rabies. — 'SI. Auzias Turenne endeavors to establish a 
parallel between the pheiiomcna of rabiis and those of 
syphilis. It will be remembered that Marochetti con- 
sidered that the virus, after having btea absorbed by 
the wound, enters the circulation and tlun gaiiicrs 
under the tongue. From the third to the ninth day, 
small vesicles containing tlie virus appear on each side 
of the fr«num Iingu;v, and are called ly.^sa*. lie believes 
that by cauterizing these vesicles the further progress of 
the disease would be prevented. Experience has not 
confirmed these views, but M. Turenne, starting from 
the phenomena, has attempted to liken rabies to sy- 
philid, and the ly?s;c to the infecting chancre. — Do- 
minion ^fe^Ucal Journal. 

CoNSTiPATio.v. — Dr. Henry Field strongly recom- 
mends the arsenite of iion in the constipation attending 
uterine disease. Oxalate of iron is also recommended. 

Bromide of Potassitm in WnoopixG-corcn. — Dr. 
Beaufort uses the bromide with syr. of Tolu and an 
alcoholic preparation of aconite, combined together, and 
by the aid ot these three remedies he has seen the dis- 
ease cured in an average of twelve days. 

Citric Acid in After-Pains. — Dr. J. B. Chagnon 
{CanaiJa }fedical Journal) has used citric acid in jtartu- 
rient women with the most happy results. It not only 
acts as a nervine (?). but also as the best, prophylactic 
a'zainsi inflammations, such a? metritis, peritonitis, etc. 
He gives it to relieve after-pains in the doses of five 
grains in a wine-glass of water every five hours. 

TixcTURE OF Gelsemum IN Tetancs. — In the Balii- 
Tiiore Meiliral Journal is recorded a recovery from teta- 
nus, for which gelsemium was administered. Tlie disease 
1 isted seventeen days, during which time twenty ounces 
of the tincture were taken. During the first twelve 
days the patient took from half a drachm to two 
drachms every hour. 

Injury of the Eye. — Dr. II. M. Sogie {Ohio Medical 
and Suriiical Reporter) reports the following case, which 
occurred in his practice : A man was blown out of a 
mill by the explosion of a boiler. He received, along 
with other injuries, a wound over the supra-orbital arch. 
The iris was seen to be detached at i;s upper border for 
about one-fifth of its circumference, and it hung down 
near the middle of the lens, which was not detached 
from its place. There was but little hemorrhage, and 
but slight iritis followed the accident. After the patient 
had recovered from the other injuries (fracture of both 
limbsj the sight remained unimpaired, except in so far 
as it was interfered with by the inal-position of the iris. 

On the Growth of the Nails as a Means of Progno- 
sis IN Cerebral Paralysis.— Dr. S. W. Mitcliel {Arner- 
ican Journal of Medical Sciences) states that he has ob- 
served in several cases of paralysis that the nails of the 
limbs of the aflected side, on the occurrence of the 
accident, ceased to grow. This was proved by staining 
the roots of the nails with nitric acid. He was able to 
predict, in .seeing after a time a white line of nail mak- 
ing its appearance, and before there Avere any other signs 



of imjtroveinint, that jiower was about to return to the 
limit, and that voluntary motion would s-horlly be 
restored. 

AiiSENCE OF A Lung. — Dr. W. Dickey communicates 
to the Civrinnati Lancet and Observer an extremely in- 
teresting history of a ca.se which had been under his 
care, and concludes by giving the following accmint of 
the autopsy, made twelve h(jurs afier death. Tlie left 
lung was found studded with tubercles, and was eome- 
what larger than usual, but consisted of two lobts. Un 
the right side there was no lung at all, not even a 
rudiment nt the bil'urcation. Ko lung had ever existed. 
Heart in the mediastinal .space, but in the rifjht side, 
corresponding to a natural situation in the left. Its 
walls were thickened, and cavities somewhat enlarged. 

Manual Force to tue Uterus as an Adjuvant in 
Labor. — Dr. J. H. Grant (Xew Orleans Journal nf Medi- 
ciue) advocates the application of physical force to the 
fundus uteri during laiior, and gives the histories of five 
cases, where it was applied with most manifest influence 
for good in hastening the birth of the child. His Jtlan 
is to bpply both hands over the fundus uteri, and exert 
the force in the longitudinal diameter. In some of these 
cases the strength of one assistant not being deemed 
sufficient, the hands of a second person were spread 
over those of the first, and their united cfi'orts produced 
the happiest results. Where the pains were insuflficient, 
the physical pressure served to increase them, thus "ob- 
viating the use of forceps and turning, except in cases 
of malposition of the foetus." 

Efficacy of Large Draughts of Water in Poison- 
ing. — The Xew Orleans Journal of Medicine contains the 
history of a case of poisoning by corrosive sublimate. 
The patient had taken a large dose of the poison. The 
lips and mouih were much swollen; there were violent 
pain and burning heat in the stomach, and he was ex- 
tremely ill. He Wiis ordered to drink at intervals, but 
as speedil}' as possible, twelve pints of warm water, 
and that as often as he should vomit he should drink 
more. As soon as, by the pains, it w-as perceived the 
poison had entered the bow^els, the patient was ordered 
large injections of simply tepid water. The first eva- 
cuations of the stomach were extremely acrid, on tic- 
count of the quantity of the poison which they contain- 
ed ; subsequent ones were less and less acrid with each 
evacuation, until they became completely free. The 
colics which came on were treated by fresh clysters. 
These simple means were so successful that in a few 
hours the patient was out of danger. 

Case of Tetanus Cpred by Excision of a Nerve.- 
Dr. George E. Foster {Boston Medical and Surrjical 
Journal) communicates a case of tetanus, following a 
Avound made by a shoe-nail entering the heel. The 
wound healed, leaving no trace of the injury. About 
three weeks after, the patient was aAvakened in the night 
with chills, stiffness of the limbs, and sliuht tAvilching 
of the muscles of the arm. He was given all the suit- 
able medicines, but with no effect to mitigate the symp- 
toms. It was then decided to cut down and remove a 
portion of the internal plantar nerve, which was done 
with the effect of entirely relieving the spasms. The 
patient afterwards had a complete recovery. 

GossYPiuM AS AN Anodyne. — Dr. Robert E. Peyton' 
(Richmond a)td LonisviVe Med. Journ.), relates a dis- 
tressing case of phthisis pulmonalis, in which, after 
giving other remedies unsatisfactorily, teaspoonful doses 
of the fluid extract of cotton-root gave the patient'' 
much relief. 



THE MEDICAL RECOi«D\ 



109 



The Medical Record: 

A SEMI-MONTHLY JOURNAL OF MEDICINE 
AND SURGERY. 

GEORGE F. SHRADY, A.M., M.D., Editor. 



PubliJilied (»i the 1st and 15tk of each Month by 
TVilI. ^VOO» & CO., 27 Great Jones Street, IV. Y. 



New ^^orls, April 15, 1873. 



HOSPITAL APPOINTMENTS. 

It has become so much the fashion in making hos- 
pital appointments to allow almost every consideration 
save professional ability to influence the appointing 
power, that the prospect of reform seems an almost 
liopeless one. "VVe are so firmly convinced, however, 
that there must be some remedy for the evils connect- 
ed with the practice, that we are determined to make 
every effort to discover it. We are perfectly aware of 
the fact that every applicant for a position in the hos- 
pital cannot expect to be successful, but, in view of the 
large numbtu- of capaljle men who do apply, we have a 
right to, complain when the selections are not extiaordi- 
narily good ones. 

^ i'rom present indications there appears to be no jios- 
'^sible excuse for the ordinarj^ and generally accepted 
method of filling the professional positions in our large 
hospitals save partizansliip, or gross favoritism. Since 
our last remarks upon this subject, three liospitals have 
sprung into existence in our midst, the positions in all of 
which have been duly filled. No one acquainted with 
the requisites for oblaining such 'appointments is sur- 
prised at the hst of the attending physicians and sur- 
geons. The reasons why such and such men hold such 
positions are very easily explained. Here, for instance, 
is a college which must have nearly every member of 
its faculty in a hospital position, and when each mem- 
ber of said faculty who desires such an appointment is 
satisfied, it so happens that there are no places for any 
one else. The appointing power of another hospital is 
given to a single medical gentleman, and if he is con- 
nected with any pai-ticular school, as he is most sure to 
be, so much the better for the school. If he has friends 
or relatives whom he wishes to advance, no one seems 
to question his right to find positions for them not only 
in the hospital, but in the college — in fact, in the interests 
of the school he represents, both appointments must go 



together. In a hospital in which all the schools have 
a right to be represented, there are many tricks ])layed, 
and many subterfuges resorted to in order to have a 
majority representation, which, if the said manoeuvres 
were not made by some of our leading teachers, Ave 
should be privileged in calling them unprofessional, 
disgraceful, and ungentlemanly. 

We are perfectly willing that clinical teachers should 
hold hospital positions, in fact it is veiy necessary that 
they should ; but we claim that all the clinical teachers 
are not in our colleges. We fail to see how any col- 
lege, because it chooses to elect any one professor, 
can insist that such a gentleman must necessarily be a 
clinical teacher, and must, as a matter of course, hold a 
hospital appointment. Instead of colleges making 
clinical teachers, the clinical teachers should make the 
colleges. Many of the best clinical teachers we have 
seen, never held any chair in our college faculties, and 
we have a good reason for supposing that there are 
many more of the same S)rt who could use a hospital 
position to equally good advantage, if the colleges 
would graciously allow tliem the chance. If the col- 
leges would sometimes stop to consider how many 
good chnical teachers they might obtain by allowing 
an occasional outsider to hold a hospital position, and 
prove himself, by his work alone, worthy of a position 
as professor, we should have more men created for 
places, than places created for men. We are interested 
in the prosperity of the colleges, but the colleges 
cannot reasonably be expected to mean the profession. 
A gentleman who may have quietly devoted himself to 
his profession, who may have worked faithfully in a 
dispensary, and m;iy have a peculiar fitness for hospi- 
tal work and for clinical teaching, and who may be a 
thoroughly practical man, may perchance be of as 
much service in a public institution as if he Avere 
connected with some college. If we are mistaken in 
this, and if our colleges contain all the good and capa- 
ble medical men, we are forced to the huinihatmg- 
confession that by far the largest majority of the so- 
called profession are good for nothing. If we allow 
the colleges to monopolize all the hospital appoint- 
ments, and tacitly acknowledge their right to dictate to 
such as are unfortunate enough to be mere practitioners, 
we cannot escape the legii;imate conclusion that the pro- 
fession have no rights whatever in the matter. This 
is in fact quite evident from the appointments recently 
made in the hospitals named. 

We are emphatically opposed to all party influences 
in making these appointments, and believe that every 
man who applies for a position should have his claims 
impartially considered. We care not whether he be a 
professor or a " possessor," or both ; we, in the interests 
of the profession at large, call for fair play. When a 
hospital staff is to be selected, let the fact be duly ad- 
vertised ; let each applicant for the place present his 
credentials and his claims, and let these alone be the 
bases upon which his position is secured. Why is it 



no 



TlIK MEDICAL RECORD. 



necessary to keep the fact that appointments are to be 
mnde so quiet ? Why is it neccsi:nry to keep every one 
who might be imhiced to apply, in ipnorancc until all the 
places nri' fillid? Wliy is this done, if not with the 
avowed object of nionojiolizing honorable po-itionsand 
stifling legitimate endeavor? 

On a future occasion we shall present some of the de- 
tails by wliicli hospital appointments are secured to the 
select few. If any of our readers have any facts to 
communicate bearing upon tliis point, we shall use 
them in such a way as shall lend to promote the best 
interests of the profession, and the greatest good to 
our public institutions. Our .^ole aim shall be to venti- 
late the subject with a view to reform and to reform 
only, entirely independent of every other consideration 
but simple justice. We believe that this and a great 
many other matters connected with our hospital man- 
agement need looking into, and we are ready and will- 
ing to discuss them. 



AMERICAN MEDICAL ASSOCIATIO.V. 

The ne.\t meeting of the Anr.erican Medical Associa- 
tion, to be held in Philadelphia, promises to be unu- 
su dly interesting. It is the determination of the Com- 
mittee of Arrangements for that city to contribute in 
every possible way to the comfort and edification of 
the delegates. Tiiere is no doubt that there will be a 
very full attendance. New York will, we are assured, 
be particularly well represented. It is to be hoped that 
the meeting will be a harmonious one, and that those 
who attend will be spared the discu.^sion of several of 
the vexed and useless questions which have occupied 
so much time during the last few sessions. In another 
column we publish some details regarding arrange- 
ments made with the railroads for excursion tickets, 
etc. 



Ucuicius aiit) notices of Oooks. 



Lectures ox the Clinicat, Uses of Electricity. By 
J. Russell Reynolds, M.D. Philadelphia : Lmdsay 
& Blakiston. 1872. 

Electricity ix its Relations to Practical Medi- 
crxE. By Dr. Morttz JIeyer. Secoud revised and 
American edition. Translated bv Wm. A. ILv.MMOND, 
>LD. New York: 1872. D. Appleton & Co. 

Dr. Reyn: lds is one of the ablest and most cultivated 
physicians of London. On nearly all subjects of genei al 
medicine he writes sensibly and clearly, and to electro- 
therapeutics he has given mo-e attention than the 
inajority of even the most advanced practitioners. 

Tliis little work is perhaps all that it professes to be — 
a clear and suctimt statement, in language to suit 
the mind of the beginner, of some of the elementary 
princip'es of localized electric'Stn. So far as it goes 
— which is not very far — it is unusually clear. Its 
srrong meris are lucidness and common sense. Its 
omissions are, of course, enormous ; it gives but the 
alphabet of electro-theraj>eutics : the author is, to say 
the least, ten years behi::d the time; and yet very few 



writers on general medicine is as well advjtnceil in 
electro-tlicraiieuticii as he. He does not filly compre- 
hend tlie po.sition of electricity in the maii-ria medica, 
but he comes nearer to tiie truth than most writ<T8 on 
the subject. He does not mention the majority of the 
disea.ses in which it is most succi-ssful. His experience, 
though intelligent, is evidently limited and narrow. To 
depend on such manuals for our knowledge of electro- 
therapeutics would be a most serious mistake. 

Elementary lectures of this kind are more needed in 
London than almost anywhere else, for it is true, as 
Prof Huxley say->, that, excepting in political economy 
and geology, English scientists are behindhand in 
science. 8ave Altiiaus and a very few others, the 
London physicians, as were shown by a recent contro- 
versy, in the meiiical journals, between Dr.«. Gull and 
Ansiie, are only just beginning to open their eyes to 
the subject of electro-therapeutics. In no other great 
medical centre would the adverse opinion even of so 
high an authority as Dr. Gull have been thought wor- 
thy of a moment's consideration from any intelligent 
human being. 

There are three points in this work of Dr. Reynolds, 
that are of themselves worth the price of the book, 
especially for those who blindly follow in the wake of 
Diichenne and Remak. These points are: — 

1. The differential action of the currents of the pri- 
mary and the secondary coil. 

2. The difl'erential action of the two currents. 

3. The differential action of the ascending and de- 
scending currents. 

There are now in this country a very large number 
of physicians, young and old, who are diligently in- 
vestigating the subject of electro-therapeutics, and who 
would do well to obtain this little work of Dr. Rey- 
nolds, imperfect as it is, and to study it in connection 
with other text books of the subject, chiefly as a com- 
pliment to its clearness, fairness, and good sense. It 
is safe to assert that at the present time there is more 
doing in electro-therapeutics in the United States, both 
in the way of original research and in the way of popu- 
larization than in Great Britain or France or Germany. 
Like surgery, it has become an American science. All the 
American apparatus for medical and suri.'ical electricity 
are equd to, and very often incomparably superior to, 
those of European manufacture. If we are to maintain 
this advanced position, we should inpartially and care- 
fully avail ourselves of the best fruits of modern research 
in every direction. It is necessary to sow beside all 
waters. There is no book on electro-therapeutics so 
poor but that it may teach us something of real value, or 
at least give us suggestions by means of which we may 
be enabled to pursue our investigations w^ith "reater 
intelligence and success. Every* publication on the 
subj'Ct, therefore, is to be welcomed. 

The work of Meyer is now well known, and both its 
merits and demerits have been publicly recognized. 
Very far inferior to the work of Benedikt in strengtii 
and suggestiveness. it is perhaps better adapted to meet 
the general want. It gives a fair and truthful rC'Sume 
of the state of medical and surgical electricity, so far as 
we know, in Europe, at the time of publication. It is 
now of necessity considerably behind the times, though 
much in advance of Reynolds. Meyer is utterly free 
from hobbies, and evidently has no prejudices. His style, 
however, is more German than English ; his directions 
are oftentimes obscure, and in generalizing power he is 
greatly deficient. His want of diagnostic skill impairs 
seriously the value of some of the cases reported. 
Case 84. reported on page 396, as a case of locomotor 
ataxia, is really not locomotor ataxia at all. The 
pathological condition was probably a local and tempo- 



THE MEDICAL RECORD. 



Ill 



rary congestion of the cord— a condition which, when 
neglected, ni;iy in perhaps one c;ise out of a hunch-ed or 
tliousand, go on to be sclerosis of the posterior columns. 

We speak particularly of this case, because it will 
mislead those who are trying to cure locomotor ataxia 
by electri.nty. After the process of degeneration of the 
cord has really set in, galvanization very rarely cures, 
though it may relieve. 

The editorlias in this edition corrected several of the 
typographical errors of the first edition, and has called 
attention to the very excellent apparatus of the Galvano- 
Faradic Mfi,^ Co. 

In closing these brief notices, we may remark that no 
one who wants to keep abreast of the times in electro- 
therapeutic-? should depend on text-books, even the best 
and mo<t recent. The medical journals first herald the 
glad tidings of electro-tlnrapeutic experiment and dis- 
cover}', and one of the German year-books has a s-epa- 
rate department devoted to electro-therapeutic?, in 
which every article on the subject of any importance, 
published in any language, receives proper credit. 



Hcports of Societies. 



NEW YORK PATHOLOGICAL SOCIETY. 

Slated Meeting, Fehruary 14, 1872. 
Dr. a. L. Loomis, President, in the Chair. 

ANOMALOUS MALFORMATION OF THE HEART. 

Dr. Mary C. Putnam presented a case of congenital 
malfurmation of the heart, taken from a child wlio died 
anntng the patients of the out-practiee of the N. Y. In- 
firmary. 

The child was born at term, of perfectly healthy pa- 
rents, and for a week appeared to be quite vigorous, it 
having never presented tlie slightest trace of cyanosis. 
No examination had ever been made of the prtecordium 
for heart-nmrmurs, as no cardiac symptom had been 
presented, when, on the eighth day after birth, the child 
seemed attacked Avith viulent pain in the chest, and 
screamed for several hours. It then fell into a semi- 
comatose condition, which grailually deepened until 
death. This supervened about twelve hours from the 
commencement of the attack. It was seen by no phy- 
sician during this short illness. 

At the autopsy, the immediate cause of death was 
found in an extensive congestion of the lungs, which 
occupied them entirely, witli the exception of a small 
point at each apex. The lungs floated in water. 

The brain presented the congestion characteristic of 
asphyxia, and the same deep-blue congestion was no- 
ticeable in the corunary veins of the heart. The original 
lesion existed in this organ. Externally it was round- 
ed and quadrangular, resembling the turtle's heart — a 
resemblance that h;is often been noticed in eases where 
a communication existed between the two ventricles. 
No sucli communication was present, however, in this 
case. The left ventricle was immensely hypertrophied 
anil dilated, constituting the body of the heart. 

Contrary to expectation, as based upon the tnrgid 
condition of the coronary veins, this ventricle contained 
hardly any blood. The mitral valve was normal; the 
aorta opened into the ventricle as usual, and its orifice 
was also normal. 

The septum between the two ventricles — that in the 
large majority of cases of malformation is deviated to 
the left — was deviated to the right, and was indicated 



on the external surface by a broad fibrous line sloping 
oblicpiely from the base of the heart to the right side, 
and cutting o(f a small segment at the upper right 
angle. This segment represented the right ventii'-le, 
whose cavity had been almost entirely obliterated by 
concentric hypertrophy of its wall-;, which seemed to 
Ibrm part of the septum ventriculorum. A shallow 
depression just below the tricuspid valve was all that 
remained of the cavity. The tricuspid valve was very 
imperfect, constituted by a single membrane, supported 
at each extremity by a group of rudimentary cordal 
tendinsc. 

The pulmonary artery wis placed immediately upon 
the septum. It had, therefore, no communication with 
either ventricle, but terminaied in a cul-de-sac closed 
by muscular fibre. At the extremity of this cul-de-sac 
might be discerned two rudimentary lossje that indi- 
cated the place of two sigmoid valves, but no trace of 
the v.-ilves tliemselves existed. 

Above this point the pulmonary artery was perme- 
able throughout, although its diameter was about a 
third less than that of the aorta. The ductus arteriosus 
was quite permeable. 

The auricles were both large. The foramen ovale 
was open, but the valve well developed. The Eustachian 
valve persisted, and it was evident that the blood from 
the inferior cava liad never passed into the right ven- 
tricle, but had always been thrown immediately into the 
left auricle. The potency of the foramen ovale ami of 
the ductus arteriosus sufficiently explained the circula- 
tion. All the blood passed into the lelt ventricle and 
thence into the aorta, and, by means of the ductu'^, the 
necessary supply was sent to the lungs, not only for 
their nutrition, but, during life, for the function of respi- 
ration. The heart, therefore, was really composed of 
only three cavities, a ventricle and two auricles, and 
this is one of the rarest forms of cardiac monstrosity. 
The obUteration of the pulmonary aorta which also ex- 
isted was only an epiphenomenon of the general lesion. 
Stricture of the pulmonary oiifice is the most common 
of all kinds of foetal lesions; this orifice being afiected 
in 99 out of 153 cases given by Peacock. As is well 
known, Rokitansky first called attention to the frequency 
of lesions of the pulmonary artery in foetal life, as com- 
pared with the almost equal exclusiveness of aortic 
disease after the estabhshment of extra-uterine circula- 
tion. The explanation given by Peacock of this fact 
is very plausible, that during foetal life the pulmonary 
orifice sustains the shock of all the inequalities of pres- 
sure in the circulation of the placenta and of the um- 
bilical arteries. He suggests that such variations of 
piessure may themselves account for the localized endo- 
carditis and endoarterilis which Rokitansky poinjed out, 
and upon Avhich Meyer (ArcJiiv der Virch. 1857) has 
particularly insisted. 

In cases of pulmonary stricture from such cause, the 
light ventricle is hypertrophied. If, as is generally the 
case, the Usion occurs before the closure of the se[)tum — 
that is, before the end of the second month — an orifice 
of communication remains betv/een the two ventricles, 
as the blood is forced through this opening more easily 
than into the artery. Unt in such cases also the septum 
is deviated to the left, the aorta to the right, and arises 
from the right ventricle, or from both, owing to the 
potency of the septum. Heine considers this deviation 
of the septum as the primitive lesion. To it is due the 
origin of the aorta from the right ventricle, whence, he 
says, the blood finds such great facility of escape from 
the ventricle, that less passes by the pulmonary artery. 
This, therefore, partially atrophies from defective func- 
tion. 

Atresia of the pulmonary orifice presents quite dif- 



112 



THE MEDICAL KECORD. 



fon'nt concomitant conditions from stricture. The 
septum is or is not ileviatcd; the aorta, even by Heine's 
atlinission, does not arise from the rif,'ht ventricle, and 
tliis latter is atro|phied instead of bein|,' dilated and hy- 
pertrophied. These cases of atresia of the oritice are 
extremely rare. Peacoek only quotes twelve, and of 
cases of atresia iinaceonipanied by obliteration of the 
stem of the aorta I only lind fanr recorded. Tiie heart 
nnder examination presents precisely an example of 
this rare anom;d>'. 

The moment at whiL-h the deviation from normal 
development took jilaee may be fixed at somewliere 
after the bepinnini: of the third month, for tiie septum 
ventrieulorum is closed, and before the beginning of 
the fifih, for the Eustachian valve persists. It is, in- 
deed, so complete, that it seems preserved in the state 
of its perfec-tion, at about the beginning of the fourth 
month — t!ie probable period, therefore, at which the 
hsi"!! in question occurred. 

The nature of that lesion w.-xs a matter of great in- 
terest. There was certainly no trace of emlocardiiis, 
and the hypertrophied n)uscular tissue that filled up 
tlie right ventricle did not present any obvious traces 
of myocarditis, such has been insisted upon by Stolker 
as a cause of pulmonary' stenosis. 

Dr. Pit.nwm was inclined to ascribe the hypertrophy 
to the existence of some obstacle ;it the pulmonary 
orifice, that had necessitated great efibrt on the part of 
the riglit ventricle at the very moment that the forma- 
tion of the septum was in progress. A double impulse, 
therefore, w.ns given to the growth of nmseular tissue, 
and under its inlluence this became excessive, blocked 
up the pulmonary orifice, and then, when the cavity of 
the ventricle became useless, gradually obliterated it as 
well. 

The pulmonary congestion that immediately caused 
death evidently resulted from an overloadin'jr of the 
left auricle, charged with blood both from the right 
auricle and from the pulmonary veins. The slightest 
failure of power of the dilated left ventricle would tell 
fatally upon such a morbid condition. The left ven- 
tricle was obliged both to send blood to the lungs, 
by the aorta, and receive it from tliem by the usual 
channels. The circle of circulation was too small, and 
finally btcame blocked at both ends. Then the heart 
stagirered and succumbed. 

The absence of cyanosis in this case, inexplicable on 
the theory that cyanosis depends on a mixture of 
venous and arterial blood, is easy to understand by 
those who ascribe the blue coloration to a stasis of 
blood in the venous capillaries, and to its insufficient 
aeration by the lungs. Such stnsis had not had time 
to take place during the short life of the child, and the 
moment that aeration began to be insufficient coincided 
with the invasion of the fatal pulmonary congestion. 

Dr. J.\cobi inquired if the bronchial arteries had 
been examined. 

Dr. PrT.\.\M regretted that stich examination had 
been forgotten until it was too hite, but observed that 
the sufficiency of the ductus arteriosus rendered the 
dilatation of the bronchial arteries unnecessary, and 
therefore improbable. 

Dr. J.\cobi, on examining the heart, observed that 
it was indeed a ver}' rare cnse of anomalous formation. 
He did not believe in explaining such anomalies b)-^ the 
vague term " arrest of development," for that explained 
nothing. The real question was, ii-hy had such an 
arrest occurred? In the present ca-e it was noticeable 
that the pulmonary artery was riding over the septum, 
and arrested in its progress towaids the right, while 
the ."orta was equally arrested in its march towards 
the left. He was inclined to attribute the excessive 



development of muscular fibre, which had thiikened 
the septum, clo.sed the j)uhnonary artery, and obliter- 
ated the right ventricle, to a myocardili-. He suggest- 
ed that a microscopic examination, that should reveal 
an excess of connective tissue relatively to the mus- 
cular fibres in the neighborhood of the pulmonary 
orifice, would render this origin almost certain. 

Dr. PiTNAM had intended making such examination 
for the purpose of settling this very question, but had 
reserved it until after presentation of the specimen. 

M.\.MMARV TIMOR (FIBRO-S.VCROMATOUS.) 

Dr. Post presented a tumor removed by operation 
from the lell inaunnary region of a lady aged 06. The 
ma.>-s was as large as an ordinary mammary gland, being 
the size of tl.e two fists. The patient was not con- 
scious of the existence of the tumor until November 
last. It had not been the seat of any pain, the general 
health continued good, and the integument moved freely 
over the growth. Q'here wa.s no attachment to the 
pectoral muscle underneath. The general shape of tiie 
tumor, as covered by the integument, was very nearly 
spherical ; and there were some inequalities of the snr-' 
face tiiat suggested the idea that it might be a cystic 
growth. There were no enlarged plands in the neigh- 
borhood, nor evidence of constitutional contamination 
It seemed to be identified with the mnmmary gland 
although it was separated at its upper portion. D 
Post consequently removed the whole of the gland with 
the tumor. He was, however, struck in its removal 
with the fact that the tumor was remarkaVily loose ii 
its attachments to the surrounding parts, and that then 
were no vessels of any considerable size that were divi 
ded in the operation. Only five ves.-els required to b« 
secured, and the operation was done by acupressurei 
On examining the tumor after closing the wound hi 
was surprised to find that there was no intimate con 
nection between the tumor and the mamniary glan " 
The gland was atrophied, and all attachments to it were 
very readil}' overcome by the handle of the scalpel. 

The tumor was of hard consistence, and it creaked un 
der the knife more than scirrhus. There'were no cavi 
ties in its substance containing fluid, in fact there w 
nothing like cancer-juice to be detected. The subcu 
taneous veins were considerably enlarged. The tumo] 
had not yet been examined microscopically. 

He presented the following report from Dr. Dela 
field of the microscopical appearances of the tumor : — 

Tiie tumor consists of a firm, dense tis.stie, divided u[ 
in all directions by clefts and fissures. The solid por- 
tion consists of connective-tissue fibres, mixed witi 
large numbers of oval and fusiform cells. At the edge 
of the clefts the tissue is not uniform, but is divided u] 
into large tuft.*;. The clefts are lined with cylindricj 
epithelium. The tumor belongs to a class which ha 
been described under different names by dilTerent a 
thors. — proliferous mammary cysts, cysto-sarcoma, et( 
The explanation most generally received at present i 
that theie is an intra-canaVcular growth of papillar 
tumors from the walls of the milk-ducts, at the samd 
time the milk-ducts are dilated. From this dilatation 
and the filhng up of the dilated ducts with the soli 
new growth, result the peculiar appearances seen io 
this specimen. 

The tumor is, technically speaking, a fibro-sarcom: 
inter-canaliculare mammae. 

The acu[iressure needles were removed forty-eigh 
hours after the operation, and there was a prospect o 
the wound heahng almost entirely by first intention 

DEATH FROM HEART-DISEASE. 

Dr. Finsell exhibited a heait taken from a colored 



THE MEDICAL RECORD. 



113 



woman aged fifty, Avho died suddenly while in the act 
of takuio- a cup of coliee at the breakfast table. The 
aorta was the only organ that sliowed any lesion, vvhicli 
was an extensive calcifieation jllh^t above the aortic 
valves. 

He also exhibited a heart taken from tlie body of a 
man aged 35. lie was returning home on Saturday 
evening when he met a prostitute Avho persuaded him 
to accompany lier to her lodgings. After retiring to 
her room, and fifteen minutes after having had connec- 
tion, he was seized with a fainting spell, and before aid 
could be summoned he Avas dead. The heart weighed 
twenty-four ounces, and there was atheroma of the 
aorta, with marked hypertrophy of the left vcntri^.le. 
The brain was not examined in this ca=e. 

Dr. Loomis was of the opinion thnt very few of the 
large number of sudden deaths occurred from heart- 
disease, although the heart was found to be diseased at 
the time. This statement Avas founded on a careful in- 
vestigation of 155 typical cases of heait-disease. 

Dr. Post remarked that sudden death might be of- 
ten caused by a minute lesion of the medulla oblonga- 
ta, which lesion might be very readily overlooked 
during an autopsy. 

Dr. J. C. Petkrs in tliis connection referred to the 
case of a patient fif his, in whom the only cause for 
suilden death was fatty degeneration of the heart. 

Dr. Loomis stated that, about a year and a half since, 
lie exanuned a gentleman, eleven o'clock in the morn- 
ing, and gave the opinion that the heart Avas perfecly 
sound. The patient Avas in apparently good health at 
the time. At one o'clock in the same afternoon he 
died suddenly. A fcAV days before, this patient had 
had his life insured for twenty-five thousand dollars, 
and a gentleman Avho Avas called in after the death had 
occurred offered the opinion that tliere had been heart- 
disease. After considerable effort Dr. Loomis obtained 
an autopsy, and succeeded in satisfying himself that 
death Avas due to a large effusion of blood at the base 
of the brain. Theie Avas a slight atheromatous condition 
of the aorta, and the left ventricle Avas very slightly 
hypertrophied, but these lesions were insignificant. 

Dr. Putnam suggested that a broad distinction should 
be made between aortic and mitral disease in regaid to 
the liability of sudden death. Recent statistics had 
shown that aortic insufficiency was particularly liable 
to be followed by sudden death, and an ingenious ex- 
planatiun had been given of its mechanism. When the 
aortic valves are sufficient, the blood, suddenly arrested 
by their closure, is forced into the coronary arteries 
that arise behind them. When they are insufficient, 
a li-rge pait of the blood passes back into the ventricle, 
and does not pass into the coronaries. At all events, 
the jet is not thrown Avith the normal force. The Avails 
of the ventricle, therefore, are c mstantly growing 
weaker from insufficient nutrition, while the cavity is 
dilating from the increase of its contents, and the 
brain suffeis from the general antemia so cliaracteristic 
of aortic insufficiency. At a given moment, the com- 
bination of these influences reaches some special crisis, 
the heart staggers under an excessive afflux of blood, 
at the A'ery time that it is deprived of its normal 
stimulus from ner\'ous influx, and from the blood fresh- 
ly circulatirig in its nutritive arteries, with an increas- 
ed burden and less power to bear it, the heart comes 
to a stand-still, and pauses in diastole. 

Dr. Jacobi maintained that it Avas hard to prove or 
to disprove this theory, except by tlie facts of clinical 
experience. If the idea Avere tenable that the heart 
Avill gJA'e out suddenly when not sufficiently nourisherl, 
it was impossible to see Avhy a large number of persons, 
under severe physical exertion and under great mental 



emotion, should not die upon the spot. Tt appeared to 
him that inasmuch as a large portion of tlic lieait could 
be di.-integrated without causing inmicdiate death, a 
sudden arrest of blood in the coronary could hardly 1)0 
charged Aviih producing a fatal result. 

Dr. Loomis remarked that the clinical hi-tory of 
cases of aortic regurgitation militated against the 
theoiy of sudden death from arrest of supply through 
the coronary artery. Aortic regurgitation lir>t causes 
a dilatation of tin; ventricle ; that dilatation is imme- 
diately compensated by hypertrophy of th(! ventricular 
Avails, The hypertrophy goes on j^u^'i passfi Avith the 
dilatation until degenerative hypertrophy commences, 
Avhen the dilatation gets the best of the race. Then it 
is that the patient is in a condition to invite sudden 
death, when the heart may be overtaxed. 

Dr. Jacoei had never been able to convince himself 
that any of his cases of death from heart-disease 
occurred suddenly. lie did not recollect having seen 
a case terminate in death in less than tAVO hours. Such 
an one he called to mind in the person of a boy, 
Avho died in two hours and a half from pulmonary 
oedema. 

Dr. Peugnet referred to the case of the late Dr. 
Canimann, Avho died of degenerative hypertrophy, 
caused by aortic ami mitral disease. 

PULMONARY APOPLEXY. 

Dr. F. exhibited also a case of pulmonary apoplexy 
of the right lung, removed fiom tlie body of a German 
aged 65. He Avas engaged in a quarrel with one of his 
tenants in reference to chopping some Avood. It Avas 
claimed that he was struck Avith an axe in the quarrel, 
and that he had died in consequence. At the autoj sy, 
hoAvever, no marks of the axe Avere to be found. On 
removing the calvarium a large effusion of serum, 
amounting to eight or ten ounces, w^ns discovered l>y 
Di-. Cushman underneath the arachnoid. If there Avas 
such a thing as serous apoplexy, Dr. F. Avas inclined to 
call this such a case. The brain Avas not congested, 
neither were its vessels gorged or distended. On open- 
ing the chest the right lung Avas discovered to be the 
seat of extensive pulmonary apoplexy. It was clear 
that death Avas caused by this latter effusion, combined, 
perhaps, Avith the serous apoplexy. The fatal result 
occurred about an hour after the fracas. 

Dr. Jacobi asked if the convolutions Avere not hard 
and flattened, and on being answered in the aftirmative, 
expressed the opinion that the supposed serous apoplexy 
Avas evidently an old process. 

DEATH FROM PYEMIA AFTER THE DIVULSION OF STRICTURE. 

Dr. Keyes exhibited a specimen of death from 
pyremia after the divulsion of istrieture. A Scotchman, 
aged forty, Avas last month sent to hospital fi om the 
workhouse. He was a stout, heavily built man, and 
complained of stricture Aviih cystitis. A number 11 
bougie (French scale) Avas readily passed, and, as the 
patient desired to be relieA^^d of his trouble, a Thomp- 
son's divulsor Avas introduced, and screAved up to 30. 
The patient did not complain of any pain, until a No. 
25 sound was passed, Avhen he also had a chill. A sub- 
cutaneous injection of morphia Avas made into one of 
his arms. Shortly after this he passed into a condition 
of fever, Avhich lasted until death. The chill lasted 
five minutes. His pulse went up very rapidly, so that 
the next day it Avas 130-140. His skin was hot and 
dry from one end of the disease to the other. He 
drifted into a condition of delirium on the third day, 
and his skin becairie yelloAV tAventy hours before he 
died. 

It Avas discovered that there Avas a little tenderness 



114 



THE MEDICAL RECORD. 



beneath the scrotum, and on the tliinl day n lump 
nboiit tlu' size of a marlile was discovered. The pa- 
tient diod on tlie nintli day. 

At the aiiiop.sy it wa.s di.'^covered that there was ex- 
trava-atioii of urine; that there had formed pu.s in the 
meshe.s of the scTotuin: that tliore was a small abscess 
in the Moor of the urethra, just in front of tlie stricture. 
There were also three aljscejses in th" pro.statc. The 
bladder was hypertrophiod to a certain extent, and 
pave evidences of the existence of clironie cystitis. 
An ab<ces> the size of a marble was found in the sum- 
mit of the left \uw^ ; the liver and spleen were soft, but 
contiiined neither abscesses nor infarctions. There 
wai> no trouble with tlie kidney*. The cavities of the 
pleurje contained serous effusion, with a few floating 
flocculi. 

Tne specimen wa.s of interest as showing the results 
of divulsion, viz. : tearing through of the mucous mem- 
brane and of the stricture tissue, and als) as a case 
terminating with pyaemia as the apparent result of the 
operation. About five days after the operation the 
patient was recognized by two others, who had seen 
him in a strait-jacket, with violent mauid a potu, three 
days bef ire his admission to the hospital. This fact 
explained the reason why the condition of the patient 
was such as to invite suppuration so readily. In fact, 
this conlition was very manifest in the beliavior of the 
hypodermic punctures, which degenerated into diffuse 
.suppuration. The chill evidently did not have any- 
thing to do with the pyaemia as an initiative. 

The heart was enlarged, the lungs cedeniatous, and 
the pericardium was adherent to the stomach. 

EFFECTS OF HYPODERMIC IXJKCTION OF RESKNOID OF VER.\- 
TRCM ALBUM. 

Dr. PErGNKT presented the stomach, intestines, 
uterus, and bladder of a slut, which were intensely in- 
jected ; the coats of the stomach and intestines thick- 
ened, and he believed presented evidences of inflam- 
matory action. The specimen was un'que. and the only 
recorded one having been produced by the hypoder- 
mic iniection of j? gr. of the resinoid of veiatrnm album, 
that is, its re-in deprived f)f its alkaloids, veiatroida (so- 
called verat:ia) and j^rvina. It contains a distinct 
organic principle, but not of basic origin. He had made 
several experiments on various species of animals, but 
had invariably obtained similar results, varving in in- 
tensity as to the amount of resinoid administered, and 
to the length of time it took to cause a fatal termina- 
tion ; whilst he had never seen any similar effect pro-' 
duced either by the veratroida or the jervinn, although 
variou- observers had attributed this peculaiar action 
of veratrun allmm to its veratroida. He con-idered 
thv. in this principle resided the marked difference 
between veratrum album and viiide. The kidneys and 
ureters were normal, the liver dark and c.mgested, the 
heart distended, ventricles filled with blood; ri<.'htlung 
cingesteil, with ecchymotic spots on its surface, but 
readily inflated. Its peculiar effect on the uterus 
showed that t!ie cases of hemorrhage alluded to by 
Orfili, in his treat-se on toxicology, as well as the case 
which had come imder his own observation, was not 
due to its mechanical action as a sternutatory when 
applied to the nostrils, but to the congestion developed 
in the uterus. 

It is a c;irdiac poison, causing death by stopping the 
heart's action at the diastole, owing to a gradual de- 
struction of the excitabihty and conductive power of the 
nerves of tiie organism, probably due to a paralysis of 
the blood-vessi-ls of the nerve-centres. 

Dr. J. C. Pkters alluded to the specific action of 
certain medicinal agents on the alimentary canal, and 



inquired if there had been any tiiminution of the 
temperature in this case. 

Dr. Pkuo.vet re[»lied affirmalivel}'. 

Dr. Petkrs thought that it was intense hypcrajmia 
or congestion, due to a paralysis of the vasa-motor 
nerves. 

Dr. PEroNET admitted that the hyperaimia or con- 
gestion, as suggested by Schroff and confirmed by 
(iililer, in reference to veratrum, would be accounted 
for by paralysis of the vasa-motor nerves as its primary 
action, but that if the animal lived long enough, gas- 
tro-enteritis would be developed as a secondary one, 
as observed by him in a case of poisoning, where the 
patient took half an ounce of the homoeopathic mother 
tincture of veratrum album, and was confined to her 
bed for eight weeks, presenting all the symptoms of 
gastro-enteritis, finally recovering with a contraction 
of the colon, which caused an extreme attenuation of 
the faeces, and that they only recovered their natural 
form and size four months after. 

Dr. Jacobi remarked that Dr. Peugnet had been 
carrying on extensive experiments with the different 
varieties of veratrum, and suggested that he should 
make a micrcscopic examiiiation of the specimens. 

The Society then went into Executive Se.-sion. 



Stated Mediwj, Fehniary 28, 1872. 
Dr. a. L. Loomis, President, in the Chair. 

FOLLICULAR ULCERATION OF PREPUCE. 

Dr. Post presented the inner portion of the lining 
membrane of the prepuce removed by excision from a 
married man aged forty-eight. The patient had a long 
foreskin, which could be retracted only with difliculty. 
The disea.se consisted in an extensive granulating ulcir- 
ation, and also induration. It presented none of the 
physical characters of the initial sore of syphilis, neither 
was there any syphilitic history connected with the pa- 
tient. None of the glands in the neighborhood were 
enlarged. The ulcer was indolent in character, had 
exi-ted for a period of three months, and seemed, in the 
absence of anv other cause, to be due to a want of 
cleanlines-s. The specimen was, on motion, referred to 
the Committee on Microscopy. 

PERFORATION' OF APPENDIX VERMIFORMIS BT F.ECAL 
CONCRETIONS. 

Dr. Mason exhibited some faecal concretions re- 
moved from the appendi.x vermiformis of a stout, heal- 
thy boy aged eleven years. The patient was taken 
sick on "Wednesday, December 7, with what appeared 
to be a .simple attack of cholera morbus. In the 
morning his motlier gave him a dose of oil, which pro- 
duced four or five large evacuations. Dr. Mason was 
called to the patient on the afternoon of Thursday. 
There was then a good deal of pain in the abdomen, 
most intense, however, in the neighborhood of the 
right iliac region. The nature of the casf was at 
once suspected and an Ofduion given accordingly. The 
patient was put under the opium treatment, and was 
seen again at ten p.m. The pain was somewhat 
easier, although it had exfende<l to the left side, where 
there w;is also some swelling. There was then decided 
tympanitis over tl:e whole abdomen. The opium treat- 
ment was continued, when on Friday night the 
pain became more intense. Six leeches were applied 
to the part, with some benefit. The tympanitis in- 
creased very much, and the pain seemed to be more on 
the left side than on the right. 

The temperature had been 103' F. ; pulse 130, and 



THE MEDICAL RECORD. 



115 



respiration corresj)on(Ungly rapiil. On Friday these 
symptoms improved, the temjierature fell to 98, but the 
tympaniiis was still very eonsiderable. In fact, he ap- 
peared to be so comfortable that hope was entertained 
that there had been a mistake in the diaunosis, and that 
the peritonitis was due to other causes than perforation 
of tlie appendix verniilbrmis. On Friday night and 
Saturday morning, however, all the symptoms became 
suddenly worse ; there was intense pain in the region 
of the diaphragm, and the pain in the left side also be- 
came more considerable. On the Sunday following, he 
being no belter, Dr. Flint was called in consultation, and, 
despite a very careful examination, no tumor could be 
detected. The case was then regarded as one of gen- 
eral peritonitis, due to other causes than those which 
referred to the appendix. He gradually grew worse, 
and sank on Monday morning, lie died just seven 
days after he was fust taken sick. During the last 
twelve hours of his life opium seemed to have no effect 
in allaying pain, notwithstanding over a hundred drops 
of the tincture were taken in three hours. In addition 
to this, a grain and a half of morphia was injected sub- 
cutaueously, but with no marked elTect. As a last 
resort, chloroform was administered continuously dur- 
ing the last six or eight hours of life. 

Autopsy. — On opening the abdominal cavity, there was 
not that escape of gas which we usually notice in per- 
forations of the appendix, but intense peritonitis was 
very evident. The ascending colon was bound down 
by a false membrane which surrounded the whole of it ; 
and directly behind the colon, commencing a little 
above the crest of the iUum, was a large abscess, which 
extended along the under surface of the diaphragm. It 
was covered by a thick layer of lymph, and so were the 
upper and under surfaces of the liver. The intestines 
on the left side were also bound together by a large 
collection of lymph. The appendix was unusually long, 
measuring about five inches; and there were two per- 
forations in it, the upper one about an inch and a iialf 
from the commencement, and the second about half an 
inch below the first. Projecting through the first open- 
ing was a concretion about the size and appearance of 
a date-seed. The extremity of the appendix was in a 
gangrenous condition. During all his sickness there 
was no trouble in evacuating the bladder. 

The concretion was nothing more than hardened 
fecal matter arranged in concentric layers. There 
were eight of these rings, and in the centre of the mass 
was a wiiite substance which resembled lime. 

There was no swelling on the right side, that might 
have led to the suspicion that there Avas an abscess in 
that situation. Even if there had been a certainty that 
an abscess did exist, there would have been no chance of 
reaching it by an operation, the collection of pus being 
much higher than usual in these cases. 

The tvmpanitis was so extensive that the practica- 
bility of puncturing the transverse colon was seriously 
entertained. In conclusion. Dr. Mason remarked that 
Dr. Parker advised, before operating in these cases, to 
wait until the fourtli or fifth d;iy, but in the present 
instance the peritonitis conunenced from the start. 



New York City Lun.\tic Asylum. — Dr. R. L. Par- 
sons, Resident Physician of this Institution, in his an- 
nual report ibr 1871, states that 780 patients were ad- 
mitted during the year 1870. 453 were discharged. 
132 died. Of those discharged, 212 recovered; 129 
improved; 112 showed no improvement. The irn- 
poitance of greater care on the part of physicians who 
sign certificates of insanity is forcibly dwelt upon by 
th^s writer. 



NEW YORK ACADEMY OF MEDICINE. 

Stated Meeting, March 7, 1871. 

Dr. E. R. Peaslee, President, in the Chair. 

{Discussion on Dr. Loving's i^aper, vide imge 97) 

Dr. Notes. — I agree with the statements made by 
Dr. Loring in the rules for peribrming the operation for 
strabismus. The certainty which can be secured in the 
cosmetic eflect by attention to these rules is in strong 
contrast with the variahle and sometimes deploraljlo 
lesults which followed the operation in its beginning. 
Yet even now a slight divergence wi'l sometimes ensue 
after operating for convergence. This is doubtless due 
to the extent of incision made in the capsule of Tenon, 
and what Dr. Loring said about the variable strength of 
this tissue is to be remembered in making the subcon- 
junctival incision. I have not been favorably impressed 
by the so-called subconjunctival method of operating, 
but choose rather a small opening over the insertion of 
the muscle and close it up by a fine suture. In only 
some rare cases have I employed the suture through 
the outer canthus, which Dr. Knapp first suggested ; I 
have found it answers the indications. I have not 
been in favor of operating upon very young subjects. 
My reason is that, at a very early age, it is impossible 
to use those optical appliances which are indispensable 
to many cases of strabismus. The problem is IdiIi 
optical and mechanical, and I do not find any certainty 
in the results unless the optical conditions are fultilled. 
Hence for a young child in whom the convergent st a- 
bismus has not become decided, I prefer to postpone 
the operation until 6 or 8 years of age, and, to avoid 
impairment of sight by disuse of one eye, direct the 
parents to cover the eye, which is habitually used so 
that the child may be compelled to keep up the practi;'e 
of using the other. In one class of cases, I am stron<.ly 
in favor of not operating at an early age, viz. whei-e 
strabismus, as is not infrequent, comes from opacity ot 
the cornea. This kind of strabismus is extremely apt 
to disappear or to greatly diminish as a child grows. 
Probably because, as the opacity fades away and vision 
improves, the effort to see makes less demand on the 
accommodation, and consequently less on the interni. 
For such cases there is hope of a spontaneous cure, and 
danger that an early operation may at length bring 
about divergence of the eye. 

I have seen a statement by some one that he had 
obtained binocular vision in from GO to 80 per cent, of 
cases operated on. If by this is meant that true binoc- 
ular vision, as distinguished from apparently correct po- 
sition of both eyes, was secured, I am at a loss to credit 
the statement, li is perfectly true that in this propor- 
tion of cases the eyes may, so far as their motion and 
look is concerned, act like a normal pair, and the person 
be supposed to have binocular vision. But in very many 
such cases, I have been wholly unable to get evidence 
that there was true binocular vision. Tests fur double 
images and by the stereoscope and by other means 
would show that one eye only was employed in seeing. 
and the other followed after in a merely mechanical 
way. I do not believe that true binocular vision, the 
conscious participation of both eyes, is secured in more 
than 25 to 35 per cent, of the cases. The cosmetic re- 
sults, however, which are what the public demand, are 
far superior to this ; but the aim of the surgeon is to 
restore the physiological unity of the two eyes il' possi- 
ble. This subject,' however, is a very large one, and 
on this branch of it Dr. Loring has not touched. For 
strabismus as a purely surgical proceeding, he has 
certainly stated the appropriate rules of treatment. 



116 



III: MEDICAL RECORD. 



Dr. Roosa would like to ask Dr. Loring in regard 
to a point made in the bopiniiing of his papi-r as to the 
causation of squint. Ilr luulerstooil Dr. Loring to say 
thit lie disiigreetl with Dontli-r's statt,'Mi('nt, that there 
were scarrely any cases of convergent squint tliat were 
not causi! 1 by a shortened condition of the eyeball 
(hypennclropia) ; and to state, that there were many that 
were dependent upon straining ortheaeconiniodation and 
weakness of the externi. While the speaker under- 
p'ood and aec -pted this view, lie wished to know if Dr. 
Loring meant to teach, also, that the habit of imitation, 
«. <"., a child imitating one who squinted, would of itself 
cd'ixe strabismus. 

Dr. Roosa also asked if Dr. Loring made a literal quo- 
tation from Stdlwag in regard to the time for operation. 
He liad been under an impression, probably erroneous, 
that StelUvag recommended the period at which chil- 
dren began to use their eyes upon near objects as the 
proper one for operation. 

In regard to the first question, Dr. Loring said that 
Dr. Roosa must have misunderstood him. as be had not 



and adJuctive excursions of the squinting eye were 
equal to those of the fixing eye. 

Concerning the possibility of determininq the effert ai 
an oriihtr ieiiotoini/, Dr. Knapp thought, with Von 
Graefe, that this could be done liy a ean-ftil operator, 
with an approximation sufBeit-nt to promi.sc a sucfe.^s 
in all casf'se.Ki'cpt. perhaj)S, two or three percent., which 
also might still be corrected by a subsecpu-nt advance- 
ment. The ell'ect of each operation had to be examined 
and modified, if necissary, one or several hours after 
the tenotomy. There was no need of waiting eight or 
twelve hours for making these examinations and cor- 
rections, and if Von Graefe recommended so long an 
interval, his practice was strangely at variance with hi,- 
teaching. lie hardly ever performed an operation be- 
fore three or four o'clock in the afternoon ; and it, would 
have been rather inconvenient to make the corrections 
eight or twelve hours la'er. 

In regard to the re-estahliRhrrtenf of stereoscopic visioii. 
by the operation for squint, Dr. Knapp confessed him- 
self to be the author of the statement Dr. Xoyes had 



alluded to the fact that strabismus could be caused by I alluded to, thongh he <lid not now remember the per 
imitation. What he intended to say was that often- centage of oases in which stereoscopic vision Ava-; ob- 
limes a condition was produced in emmetropic eyes by tained. He had, eight or nine years ago, compiled a 
debilitating diseases which gave rise to factors which larger number of .successive squint-operations made by 
were precisely similar to those which existed in hyper- ( him, and, if his memory served him, about CG per cent 



metropic eyes from congenital malformation. Thus 
some temporary reduction in the power of the ciliary 
nmscle would Ibree emmetropic eyes to use an increas- 
ed amount of accommodative effort with moderate 
degrees of convergence, which is the essential cause of 
squint. 

In regard to the passage in Stellwa'j, Dr. Loring re- 
maiked tliat he had copied it from the last edition of 
the American Translation. 

Dr. Kn.\pp remarked that the snhconjunctivril tenotomy 
was neither difficult nor uncertain, but had the advan- 
tage of causing less extensive wounds, smaller effects, 
and less tendency to sinking of the caruncle and protru- 
sion of the e5'eball. If, on examination after the opera- 
tion, the effect was found to be too small, it was easier 
.|ind surer to increase it to the desired extent by divid- 
ing the conjunctival bridge over the previous insertion 
of the tendon than to reduce, by means of sutures, too 
great effects which followed not infrequently the ordi- 
nary tenotomy, as advocated by Dr. Loring. 

Dr. Kk.\pp described the mode in which the subcon- 



or 75 per cent, of them were followed by binocid.ir 
fixation in all available parts of the visual field. Graefe, 
who had published statistics less favorable, had later 
declared himself in agreement with Dr. Knapp's residts, 
since he had operated on children more frequently than 
he used to do before. 

Dr. Knapp was of opinion that strabismus should h" 
operated on us soon as it was manifest. Postponing the 
operation, very rare cases of spontaneous recovery ex- 
cepted, could only place the patient into less favorable 
conditions as to the preservation of good sight in the 
.squinting eye, and the restoration of binocular vision, 
which was the less apt to take place the longer strabis- 
mus was allowed to exist. He had repeatedly and al- 
ways successfully operated for congenital squint on 
children, three or four months old. The operation, in 
the first years of life, was rather difficult, and threw a 
great responsibility on the operator, as he had less 
factors at his command to calculate tlie desired effect, 
but the innate tendency to binocular fixation then was 
still in great force, and commonly compensated small 



junctival tenotomy should be performed, stating that a j inaccuracies of the operation. As a ruleless extensive 
neat operation required only four or five strokes with j tenotomies should be made in children, and even in 
the scissors, two for the division of the conjunctiva and i subconjunctival operations limiting sutures were often 
Tenon's capsule, and two or three for the division of | necessary. In no case, whether of an aflult or child, 
the tendon. j the mobility of the operated eye should be reduced be- 

With regard to the application of sufitres to increase yond the natural limit. This was the mechanical and 
or diminish the efed, he said that Graefe's plan, of pass- ' most important side of the operation for strabismus 



in^: sutures only through the conjunctiva, mostly gave 
insnfficient effects, at any rate the obtainable results 
could not be calculated wirh any degree of certainty. 
Oblique sutures, if they had any effect upon the tendon, 
were ii.able to change its physiological direction, caus- 
ing secondary d<;viation of the globe, and should 
therefore be avoided. 

The opjr.ition for squint was mainly a mechanical 
problem. In the development of internal squint there 
was always a strugtrle between forced convergence and 
forced accommodation, or between stereoscopic and 
a -ute vision. Which of the two got the ascendency, 
seemed to be more or less accidental. A weakness of 
the external recti, which Dr. Loring alleged, could not 
be regarded as a predisposing cause cJf convergent stra- 
liismus, as one of the essential features of concomitant 



In convergent squint, experience had taught him that 
the effect of a tenotomy was excessive, if, one or two 
hours after the operation, the inner margin of the 
cornea could not be moved as far as to the caruncleJ 
The success of squint operations, in his opinion, de4 
pended more on the close observance of these mechanij 
cal laws, than on most of the other factors that enterea 
into the problem. 

Dr. R. H. Dkrby. — I cannot agree with Dr. Knap^ 
at all in his estimate of the value of Von Graefe'a 
suture. In excessive degrees of convergent squint w< 
can accomplish by this suture any possible desired cor4 
rection. A methodical increase of the effect of the oper-j 
ation of any degree may by this means be secured| 
Von Graefe found this suture of so much value that bt 
latterly almost never practised the operation of .sewing 



squint was the maintenance of power both of the inner ! forward the muscle.' The danger that Dr. Knapp 
and outer recti, shown by the fact that the abductive | alludes to of the obliquity of the suture causing a ver 



THE MEDICAL RECORD. 



117 



tical dovi.ition of the optical axis is, if the suture be 
properly apphed, ratlier imaginary than real. Acoord- 
ir.g to the breadth of the transfixed bridge of conjunc- 
tiva the eye lolls more or less toward the nieiHan line. 
If ih(^ amount of convergence was excessive, more than 
3-4 hues, I have been in tlie liabit of contenting myself 
with a partial correction of the squint and ultimately 
making a compensatory^ operation on the fellow-eye. 
During the period of my assistantship at Von Graefe's 
elinique I had almost daily opportunity of seeing the 
value ol' this suture to increase ti'.e effect of a tenotomy, 
and 1 have never known it to reduce a vertical squint. 

Von Graefe has long since pointed out the impor- 
tance of making the conjunctival wound very small in 
the operation of tenotomy. Sinking of the caruncle is 
by this precaution reduced to a minimum. After an 
operation for convergent squint there should remain 
two or three weeks after the operation a convergence 
of tliree-quarters to five-quarteis of a line. This is not 
merely lor the sake of cosmetic eft'ect (that is on ac- 
count of the apparent divergent squint of hypermetro- 
pic eyes), but because after this period there is always 
a gradual increase in the effect of the operation. 

Especially important is it, after a squint o]ieration, to 
ascertain, by means of a prism with its base downwards, 
the dynamical relations of the lateral muscles ; for often 
after a tenotomy for convergent squint there is a ten- 
dency to divergence. Should we now find a prepon- 
derance of muscular action in favor of the external recti 
we mu>t see that enough accommodative effort is called 
into play to counteract the tendency to divergence. 

Of the amblyopia that is fouml in monolateral squint 
three stages or rather forms have been distinguished. 
In the_/fr.s^ form the acuity of vision is diminished — there 
|is simple dulness of the retina. In the second form the 
Ipower of fixation is impaired; the patient makes a feel- 
ing movement with the macula lutea, and he sees 
jobjects better that lie toward the temple than those 
that lie toward the nose.* In the third form the inner 
half of the retina has better vision than the macula. 
■This classification is of great importance for the prog- 
'nosis. The dulness of the retina described under the 
Uirst form is entirely curable and often disappears im- 
niediately after the tenotomy. In the second form the 
jimprovement comes, but is only partial and gradual. 
I For the third form the chances of improvement are 
very small. 

I Dr. T. R. Pooley concurred with Dr. Knapp in 
ithinking the subconjunctival the best method of oper- 
iating. It was not difficult of execution, provided the 
l.^onjunctiva was grasped close to the sclei'otic, so as to 
iinsure the opening of Tenon's capsule. The method of 
ipperatiug proposeil by Dr. Loring, of introducing the 
(jiiook from above, and exoosing the whole insertion of 
' the muscle, and the too free dissection of the capsule, is 
likely to be followed by undue reaction. The vertical 
-'Uture could have no diminishing effect. A suture de- 
signed to diminish the effect of the tenotomy should be 
passed horizontally in a place with the muscle and 
leeply enough to embrace part of the tendon in its 
grasp. Ho thought it advisable to operate without an 
Hannesihetic whenever practicable, in order to control 
the elTec's as soon after the operation as possible. 



The Endoscope. — Dr. Robert Newman, of New York 
Trnns. Med. Soc, X. Y., 1870), gives a practical paper 
jon the use of the endoscope in the treatment of dis- 
jeases of the female bladder and urethra. It is pro- 
fusely illustrated with diagrams. Six cases, selected 
from many others treated at the Woman's State Hos- 
jpita', under the care of Dr. T. A. Emmet, are detailed. 



CotrespoutieiiCie. 



Ipita' 



THE SELLING OF DIPLOMAS. 

To THE Editor op the Medical Record. 

Sir : Duty to myself, not favor to persons or colleges, 
— for I never knowingly do favors where crime may 
possibly be abetted thereby — renders it requisite to say, 
that on further investigation, I find that there is no 
evidence within my reach, which will justify the fol- 
lowing raragraph of my letter published in the pEconn 
of the 15th March inst. as regards the College alluded to. 

"Besides such outrageous acts, it is credibly stated 
that this same college advocates the propriety, and fol- 
lows the practice, of selling their diplomas to persons 
living in distant parts of the State, on the simple state- 
ment of the person seeking it, without any presentation 
of certificate or credentials. " 

I had either misapprehended the statements alluded 
to, or they incoirectly represented the only written 
evidence I have yet seen upon this matter of the prac- 
tice of the said college, of giving diplomas without 
examination. 

So far as the evidence before me goes, the college 
offers to examine any graduate of a medical college, 
and, if satisfactory, to give him a diploma for ,$35. 

It also oflers to receive the diploma by mail, or in- 
deed any certificate of graduation, and, excusing the 
examination, 'issue a diploma for $175, that is, charging 
$140 more when they do not examine, than when they 
do examine. 

Respectfully, 

Stephen Rogers. 

March 30th, lS7;i. 



Hciu 3nsttuntcnt3. 



DESCRIPTION OF A 

NEW SCARIFICATOR TO FACILITATE 
VACCINATION. 

By B. F. DAWSON, M.D., 

ATTF.N'DING PHYSICIAN TO THE NEW YORK STATE WOMEN'S HOS- 
PITAL, ETC. 

The threatened epidemic of small-pox during the pa-t 
winter greatly increased the vaccinating duties of phy- 
sicians. In the frequent performance of the operation, 
in common with many others, I felt the necessity of a 
scarificator which would combine the three great re- 
quisites of painlessness, rapidity^ of action, and sim- 
plicity of mechanism. While thinking over the mat- 
ter, the following instrument suggested itsell", and 
through the assistance of Mr. Stohlman, of G. Tie- 
man & Co., of this city, has been just prit into form. 

The accompanying illustration represents the exact 
size of the instrument, which admits of its being car- 
ried in the vest pocket. 

The construction of this instrument is as follows : a 
simple tube through which runs a steel rod connecting 
with the handle («), 3.nd terminating in six needle 
points shown in woodcut; a spiral spring encircles this 
rod, being fistened to it at the needle extremity and 
connecting with the outer tube at the insertion of the 
liandle (a). A rachet catch (e) prevents the recoil of 
the spring when wound up, which is done by turning 
I, the handle (a) with the right hand, from riijht to left, 



118 



THE MEDICAL HECOKD. 



until it winds no further. The regulatin}? i>icce (h) en- 
ablrs tlif ile-ired exposure of the lU'cdlcs, which shouhl 
projt'ct but sliglitly beyond tlie end of tlie instrument, 
'file intitruinent, being wound up, is ready for use. Tlie 




operation is performed by taking the scarificator in the 
right hand, the thumb being against the rest (</), and 
tlie sfcond fini^er lightly resting on the spring lever (c) ; 
the fir.<t fingi'r lies over the instrument, and thus com- 
pletely conceals it, which is a great advantage in oper- 
ating en chi'dren. Pressing the end of the instrument 
against the arm, the second finger is instantly pressed 
against the Nver beneath it, by which act the spring is 
lilieiated and the needled instantaneou.sly revulve and 
produce three perfect circular scarifications. By un- 
screwing the regulator (/>). the needles can readily be 
cleaned by wiping or passing through a piece of soft 
paper. 

Several of my friends and others have used the in- 
strument, and to all it has given the most perfect satis- 
faction. 

When carrying it in the pocket, the needles can be 
well protected by the regulator (b). 



(Dbitimrii. 



PROF. SAMUEL JACKSON, M.D., 

OF PniLADELPniA. 

Dr. Samtel Jackson, Emeritus Professor of the Insti- 
tute of Medicine in the University of Pennsylvania, 
died, April G. at his residence, in this city, at tlie ripe 
old age of eighty-two. He was born in Philadelphia on 
the 22d of March, 17S7. He devoted his time with 
great energy to the study of his profession, and was 
successful in acquiring a high standing in its practice. 
In 1835 he was elected professor of the Institute of 
Medicine in the University of Pennsylvania, a position 
which was filled by him during a period of twenty- 
eight years, with great credit both to himself and the 
institution. He was one of the cleare-t lecturers and 
profoundest scholars, and occupied a jfront rank in the 
corps of professors of the university, a body of men 
which has long enjo\-ed the highest reputation fir skill 
and learning throughout the world. In 1863. in con- 
sequence of his advanced age, he abandoned the active 
duties of his professorship, and has since held an 
Emeritus relation to the university. Prof. Jackson 
wrote several works on medical and physiological sub- 
jects, the most celebrated of which were a treatise on 
the " Principles of Medicine," first published in 1832, 
and an "Introduction to Lehman's Chemical Physi- 
ology," published in 1856. — Philadelphia Liqnirer. 



ARMY NEWS. 

Official List of Changea of Stations and Duties of Offi- 
cers of (he ^fedica! Department, United States' Army^ 
from March 19, 1872, to April 4, 1872. inclusive. 

Fryer, B. E.. Surgeon.— By S. O. 43, Department of 
the Missouri, March 20, 1872, assigned to duty at Fort 
L'nion. N. M. 



Storrow, S. A., ARsistant Sursreon. — By S. 0. 77, 
War D-partnienf, A. G. 0., Ajiril 1, 1872, giaiittd leave 
of absence for si.xly day.»». 

Breweii, J. W., Assistant Surgeon. — By S. 0. 47, C. 
S., Department of the Missouri, assigned to duty at 
Fort Dodge, Kansas. 

Tremai.ne, W. S., Assistant Surgeon.— By S. 0. 47, 
Department of the Misi^ouri, March 25, 1872, assigned 
to duty at Fort Lamed, Kansas. 

Monroe, F. Le B., Assistant Surgeon. — By S. O. 74, 
War Department. A. G. 0.. March 28, 1872, relieved 
from duty in Department of the Platte, to proceed to 
Boston, ^^ass., reporting on arrival by letter to the 
Surgeon General. 

Latderdale, Jxo. v., Assistant Surgeon. — By S. 0. 
77, C. S., War Department, A. G. 0., granted sixty 
days' extension of leave of absence. 

Wir.soN, A. D., A.ssistant Surgeon. — Bv S. 0. 42, 
Department of the Platte. March 21, 1872. granted 
leave of absence for 30 days, on Surgeon's Certificate 
of Disiibililv. 



iHctiicnl 3tcm5 anti llcms. 



Prof. Samcel Henry Dicksdn, M.D., LL.D., died 
in Philadelphia, March 31, 1872. We shall give an 
obituary sketch of the life and services of the deceased 
in our next i.-sue. 

Dr. Samuel A. Billing, a prxjminent physician of 
Columbus, Georgia, died March 19, aged sixty-five. 

S-MALL-Pox seems to be on the increase in the city ; 
the weekly average being one hundred cases, of which 
the average mortality is thirtjj-seven. In Philadelphia 
the epidemic is on the decline, although a weekly ave- 
rage of eighty deaths is reported. In Boston the epi- 
demic is on the increase. 

In the Report of Prlr. Wunderliehi Director of Clie 
Charite Hospital at Leipsic, on the Small-Pox Epide- 
mic in 1871, we find the following statistical statements: 
Small-Pox was widespread and verv virulent. Re- 
maining in hospital, at the end of 1870, were twenty- 
six patients; new cases during 1871, 1,654; TC^hole niim-; 
ber treated, 1,680; males, 1,108; females, 572. Re- 
maining at the close of 1871, were thirteen patients, all 
of whom have since recovered, save one. .Of 141 never 
vaccinated, 101 or 71 3-5 per cent, died; of 56 unsatis- 
factorily vaccinated, 30 or 53|^ per cent, died ;" of 20 who 
had small-pox before, 5 or 25 per cent, dfdd ; of 1,463 
vaccinated, but not revaccinated, 118 or 8 per cent, 
died. Ninety-five cases of suspected small-pox were 
received, in which the disease did not fuUy develop, 
all were vaccinated and recovered. The epidemic 
was at its height between ^larch and June ; the highest 
number of cases was reached on May 21st. Towards 
the close of June the cases rapidly diminished, and in 
September there were received but ten cases. 

Vaccination. — Total vaccinations in New York, from 
January 1, to April 1, 1872, by Assistant Health 
Inspectors, was 112,181, by PoUce Surgeons' about 8,000 
additional. 

Ceuebro-Spinal Meningitis is quite prevalent in 
this city and vicinity, and threatens to become epide- 
mic. In anotlier part of the Record we publish some 
cases by Dr. Packard, which, we doubt not, will be read 
with interest. 



I 



THE MEDICAL RECORD. 



119 



Amkrican Mkdical Association. — The Twenty-third 
Annual S.'ssion will be held in Horticultural JIall, Broad 
Street above Spruce, on Tues^day. May 7, 1872, at 11 

A.M. 

The following arrangements have been made with 
the diflerent railroads : — 

Union Pacific, return free, if first-class tickets are 
bought, and an acknowledgment taken from the agent; 
Cumberland Valley, excursion tickets ; Orange, Alexan- 
drii), and Manassas, half fare for reiurn; Pittsburg, Cin- 
cinnati, and St. Louis, excursion tickets; Piitsbuig, 
Fort Wayne, and Chicago, excursion tickets; Cleve- 
land and Pittsburg, excursion tickets ; Central Railroad 
of Georgia, return free ; Richmond and Petersburg, 
return li\e ; Wilmington and "Weklon, excursion tickets 
one fare; Wilmington, Columbia, and Augusta, excur- 
sion tickets one fare ; Kansas Pacific, one and one-fifth 
fare for excursion ; Atlanta and New Orleans Short 
Line (A. and W. Pt. Western, Mobile, and M.N.O., M. 
and Texas Railroad.s, return free ; Western and Atlantic, 
excursion tickets one fare; Western Alabama, excur- 
sion tickets one fare ; Evansville and Crawford»\'ille, 
excursion tickets; Lehigh Valley, excursion tickets one 
fare; Louisville and Nashville, excursion tickets ; Mem- 
ph'S and Louisville, excursion tickets ; North Pennsyl- 
vania, excursion tickets two-thirds fare ; Pennsylvania 
Central, excursion tickets; Philadelphia and Erie, 
excin-sion tickets; Philadelphia, Wilmington, and Bal- 
timore, excursion tickets ; Philadelphia and Reading, 
excursion t ckets at two-thirds; Baltimore and Oido, 
excursion tickets; Lake Shore and Michigan Southern, 
excursion tickets, if forty are taken. 

All who desire to avail themselves of the above 

rates must send to the-Secretary, Dr. William B. Atkin- 

■ son, 1,400 Pine Street, Phila., their fall names, and the 

names of all the^ailroads over which they must travel 

in coming to the session, with stamp for postage. 

Camden and Amboy, excursion tickets at $4 from 
New York to Philadelphia and return, if fifty tickets 
are taken. For this ticket send money to Dr, A. E. M. 
Purdy, 123 East Thirt.y-eighth street, New York. From 
Montgomery, Ala#,- to Philadelphia, and return (by Ten- 
'Viessee), SS'O^SO."*^ Apply through Dr. R. F. Michel, 
?tlontgomei\y, Ala. From "Wasliington to Philadelphia 
andretuinj $6, if fifty tickets are taken. Central Paci- 
fic, half loc^l rates. 

'T«E Medical Register of New York. — The tenth 
volume "of this important work, to be issued June 1st, 
1872, un'der the auspices of the N. Y. Medico-Histo- 
rical Sociely, will contain a likeness of Dr. George H. 
Tucker, deCeaied, editor of the first Medical Register 
published in flifs country ; also a condensed description 
of the objects, character, and field of operation of the 
Hospitals, Infirmaries, Dispensaries, Asylums, and 
Medical and other Scientific Associations of New York 
City and its vicinity, and the Charitable Institutions of 
New York, New Jersey, and Connecticut, etc. It will, 
as usual, also contain inlbrmation resi)ecting the Colleges 
of these States, a List of Physicians in good standing, 
practising in New York City and adjoining places, their 
residences and office hours ; also a List of County Med- 
ical Societies of New York, New Jersey, and Connecti- 
cut, their officers and members, with post-office ad- 
dresses, and short obituaries, as i'ar as can be obtained, 
of the physicians of these counties, recently deceased. 
Committee of Publication. — Drs. Frederic Elliot, Ells- 
worth Eliot, Edward C. Woodbury, William T. VVhite, 
President, and Alfred E. M. Purdy, Editor. 

New York Academy of Medicine. — At the stated 
meeting, held March 21st, 1872, Dr. E. R. Peaslee, in 



the Chair, Dr. James L. Brown read an important paper 
on " Clim'cal Observations on Pelvic Peritonitis and 
Peri-uterine Cellulitis." Drs. Noeggerath, Barkir, Tho- 
mas, and the Presidmt entered into t'.ie discussion of 
the paper. Dr. Brown's paper will be publishtd in 
extenso in the American Journal of Medical Sciences. 

At the stated meeting, held April 4th, 1872, Dr. E. 
R. Peaslee, in the Chair, an interesting and ex- 
haustive piper, with cases, on "The Mechanism of 
Spontaneous Active Uterine Inversion, and the Reduc- 
tion of a Case of Complete Inversion by the Combined 
Rectal and Vaginal Taxi.«," was read by Dr. Isaac E. 
Taylor. It was discussed by the President ; W. C. 
Roberts, Vice-President, and the Author. 

Dr. Henry GrisAvold was elected Resident Fellow. 

The Secretary then read the names of the fallowing 
gentlemen, who were elected by the Council, Delegates 
to the American Medical Association to be held May 
7th, 1872, at Philadelphia, Pa.; Drs. Cornelius R. 
Agnew, James Anderson, James L. Banks, Gurdon 
Buck, James 0. Pond, Alfred C. Post, Samuel S. Puri)le, 
Frederick A. Burrall, T. Matlock Cheescman, John C. 
Draper, Thomas Addis Emmet, Austin Fhnt, Joel Fos- 
ter, Ehsha Harris, John H. Hinton, Edward H. Janes, 
E. Lee Jones, Ernst Krackowizer, Ciiarks Carroll Lee, 
Stuyvesant F. Morris, Jeremiah C. Morton, Charles W. 
Packard, Edmund R. Peaslee, Gouverneur M. Smith, 
Bradford S. Thompson, and William T. White. 

The President annoimced that he had invited Dr. J 
Parigot, formerly of Belgium and late of Brazil, a weli- 
known expert in psychology and psychiatry, to read a 
paper, April 18th, 1872, on " The Influence of Philoso- 
phical Speculations on Medicine : its Practice and Med- 
co-Legal Questions of Insanity." The views of Darwin, 
Huxley, Maudsley, and others of that school will be 
reviewed and combated. 

A Valuable Medical Library for Sale. — The val- 
uable library of the lat^«frof George C. Blackman, 
M.D., of Cincinnati, containing upwards of three thou- 
sand volumes of medical works, besides many pam- 
phlets, journals, and papers, is now in the hands of Mr. 
Robert Clarke, of Cincinnati, for public sale. We agree 
with the Editors of American Practitioner, that the 
library should be owned by some public institution or 
association, similar to the New York Medical Library 
and Journal Association. 

The University of Louisville. — The degree of doc- 
tor in medicine was conferred on eighty-four graduates, 
at the Thirty-Ofth Commencement of the Medical De- 
partment of the University of Louisville, held March 1st, 
1872. The ad eundem degree was conferrt-d on five 
practitioners Prof R. 0. Cowling, M.D., delivered the 
valedictory address of the Faculty. 

Chicago Medical College. — The Commencement 
Exercise of the Chicago Medical College — Medical 
Department of the Northwestern University — was held 
March 12th, 1872. Diplomas were given to thirty-two 
graduates. Two received the ad eundem degree. 

Jefferson Medical College. Phila. — The Annual 
Commencement of this College took jilace at the Aca- 
demy of Music, March IGth, 1872. One hundred and 
thirteen giaduates received diplomas, of whom fifty- 
four were from the State of Pennsylvania. Prof Joseph 
Pancoast, M.D., delivered the valedictory address. 

University of Nashville, Tenn. — The Twenty- 
second Annual Commencement of the Medical Depart- 
ment of the University of Nashville was held February 
22d, 1872. Diplomas were awarded to eighty-four 
srraduates. 



120 



THE MEDICAL RECORD. 



Women'8 Medical College, Philadelphia, Pa. — At 

the Twentieth Annual Coininencenient of tliis Institu- 
ti in, liild Miiicli 'Jlid, 1S72, thirteen huhi-s rcrcived the 
dt'proe ol" Do(.t<ir in Medicine. Prof. Henry Hart-home, 
M.D., delivered tlie closing address. 

MissKSOT.v State Medical Socikty. — The fuHowing 
officers Were elected for the ensuing year : President, 
W. W. Mayo, M.I)., Rochester, Minn.; Vice-President, 
W. L. Lincohi, M.D., Wabashun, Minn. ; Correspond- 
ing Secrcta-y, W. F. Hutchinson, M.D., MiiineapoIi.s, 
Minn.; R.-cor.iing Secretary, C. E. Smith. M.D., St 
Paul. .Minn.; Tie!U-;,ner, S. P. Shcardoun, M.D., Stock- I 
tnn, Minn. 

PiiECOi-iors DnvKLorMENT. — Fliigel de.«cribc-; in the 
liinjr. iirtzl. Intell.-BUitt. the case of a female child who 
(lied of dianluea at the age of five and a half years, 
having attained tl:e height of five feet. Tlie incisor 
tectli all appeared when she was six months old, and at 
nine months she had all the molars. At a year and a 
half of age she menstruated, and, es[)cciall3' in her later 
years, the periods were tolerably regular. The exter- 
nal genirals, excepting the absence of hair, were well- 
developed ; the breasts were full, and the pelvis roomy. 
The condiiion of the internal genitalia was not ascer- 
t lined. As regards her intellect, she did not appear to 
be in advance of other children of her age, although 
she had begun to speak when six months old. — 13r. 
}[eO. Journ. 

Deficiency ok Lime and Piiospiioiuc Acid in the 
Boxes. — Dr. Weiske shows in experiments upon the 
goat, publ shed in the Zeifschri/t far Biolor/ie, that the 
withdrawal of phosphates from the food proves injuri- 
ous to that animal, and may, in fact, lead ultimately to 
its death ; Init that the bones do not appear to be ren- 
dered therebv' more friable, or to undergo any change. 

The Jefferson Medical College of Pnii,.\DELpniA 
has, during tiie period of its existence as an educational 
institution, graduated six thousand and fifty-four medi- 
cal students. 

Carbolic Acid Pills. — The following is a useful for- 
mula : 1> Carbolic acid, 3 drops; Sonp powder, O.GO 
gram. ; Lycopodium, 0.06 gram. ; Pulv. tragacanth, 2 
scruples. Make six pills. — Drug. Circ. 

A New San Francisco Medical Journal. — A 
monthly medical journal, called The Western Lancet, 
was started in Jannary, at Sm Francisco, Cal. The 
new enterprise is edited by Eustace Trenor, A.M., M.D,, 
and Heman P. Babcock, M.D. 

Four Children at a Birth. — A woman, residing at 
Noithampton, Mas.s., gave four children at a birth. 
The mother and children were doing well at last ad- 
vices. She has had seven children within t!ie last thir- 
teen months. 

De.\dliness of "War-Weapons.— Of 3.453 Germans 
wounded before Metz, no fewer than 95.5 per cent, 
were struck by Chassepot balls. 2.7 per cent, only were 
wounded by projectiles from heavy guns, and there 
were only 0.8 jer cent, of wounds from cold steel. No 
fewer than 25,000 Frenchmen in all were struck by the I 
projectiles of the German artillery. This pives an I 
average of one elTective shot in every three fired from 
the German batteries, a result which appears hardly 
credible. 

Unfortunates in this Country. — .A.ccording to the 
late census, the class of '• Unfortunates " in the United 
States gives a grand total of 98,434. Of blind, 20,320, 
of whom 17,043 are native, and 3,277 foreign. Deaf 



and dumb, 16,205; native, 14,089; foreign. 1,336. 
Insane, 37,382; native, 20,101; foreign. 11,221. Idi- 
otic, 24,527 ; native, 22,852; foreign, 1,075. 

Baltimore College of Dental Surgery. — Since 
this insiitniion was chartered in 1839, 082 students 
have received its diploma. For many years the Balti- 
more College was the only dental institution in the 
world ; now, however, there are nine denUd colleges in 
this country. 

At the Thirty-.'jecond Annual Commencement, held 
Februiiry 29, 1872, the degree of D.D.S. was conferred 
upon eighteen graduates. 

Death of an Old Physician. — Dr. IJicharu S. Spof- 
ford, of Ncwburyport. died recently in that city, at the 
age of 83 years and 8 months. He took his medical 
degree at Harvard College in 1S15, and began practice 
in Newburyport in 1810. 

Commencements of Ohio Medical Colleges. — The 
Miami Medical College held it5 regular annual exercises 
February 29. Diplomas were presented to 07 gradu- 
ates. 

The Medical College of Ohio held its annual com- 
mencement March 1st, and 87 of the graduating class 
received diplomas. 

Death of a Promise.nt Fkexcu Physician. — Dr. 
Barthelemy Roch, President of the Medical As.sociation 
of Alais, France, since the year 1854, died lately, aged 
94 years. 

An Enormous Aerolite. — A specimen weighing 36 
tons has been pre.-ented to the Paris Academy of Sci- 
ences by the Danish and Swedish Governments. 

Secondary Haemorrhages. — In the " Surgical Let- 
ters from the Field Hospitals of Weissenburg and Man- 
heiin,"' by Dr. Tii. Billroth, of Vienna, translated for the 
K'titsfts Citij Medical Journal, from the Berliner Klin. 
Wuchenschrift, the subject of secondaiy hemorrhai.'es 
is practically discussed. Amongst the 132 wounded 
under his immediate charge at Weissenburg there were 
10 cases of serious secondary hemorrhage — 11.7 per 
cent, of all the cases. Of the sixteen, 13 died — 81.2 
per cent. If those cases seen at Manheim are added, 
there would be a total of 27, of whom 22 died — 81.4 
per cent. In the lO cases noticed at Weissenburg, the 
nature of the wounds was as follows: gunshot wound 
of the neck, 2 ; gunshot wound of the chest, 2 ; gunshot 
wound of the knee-joint, 1 ; gunshot wound of the foot, 
1; gunshot fracture of the thigh, 6; gun.shot fracture 
of the leg, 3 ; amputation o'' the thigh, 1. The hemor- 
rhages occurred Irom the fourth to the 27th day after 
the injury. In three instances — wonnds of the neck, 
leg, and toot — compression and the tampon wore em- 
ployed ; in two (wounds of the chest) deep sutures 
were used ; all five of them died. In the remaining 11, 
ligatures were applied as Ibllows : to the subclavian 
artery, once (died) ; to the femoral artery, at the bor- 
der of the sartorius, 5 times — 2 recovered, 3 died; to 
the external iliac, 5 times — one recovered, 4 died. Of 
these last 11 cases, only three succumbed as the direct, 
result of the ligation ; the rest were carried ofl' by 
pya?mia at a variable period after the application of the 
ligature, and without anv hemorrhage having occurred 
in the mean time. 

Angiom.v Cavernosum. — An important case of angi- 
oma cavernosum, situated in the external auditory 
canal and attached by a slender ped.cle to the manu- 
brium mallei, is the subject of a reprint from Knapp & 
Moos' Arrh., II., 1. The paper is accompanied by a 
well-defined steel cut illustration of the polypoid angi- 
oma cavernosum. 



THE MEDICAL RECORD. 



121 



(Drigiiral Commuu'icatious. 



A CONTRIBUTION TO 

THE KNOWLEDGE OF THE CHEMISTRY, AND 

PHYSIOLOGICAL, THERAPEUTICAL, AND 

TOXICAL ACTIONS OF 

VERATRUM ALBUM, VERATRUM VIRIDE, 

AND THEIR ALKALOIDS. 

By EUGENE PEUGNET, M.D., 



(Read before the Medical Society of the County of New York.) 

Mr. President and Gentlemen — A remarkable case 
of poisoning by veratrum album having come under 
my observation, I found, in searching its literature, 
also studying its composition ami properties, its physi- 
ological, therapeutical, and toxical effects, as well as 
thoi^e of veiatrum viride, many facts of interest as to 
their relative composition. The effects produced by 
them and their alkaloids upon the animal economy, 
although possibly not presenting anything absolutely 
new or positively origuial, I have endeavored to con- 
dense and digest into as small a compass as possible, 
hoping that they might be of interest to the mem- 
beisof this Society. 

Botanical History. — Veratrum album and veratrum 
viride belong to the same genus, their order being the 
melantheca;; Linnean system, tlie polygamia monsecia. 
Both are perennial plants, the first a native of Europe, 
found principally in the Pyrenees and Switzerland, 
the second a native of this continent, found principal- 
ly between the Canadasnnd North Carolina. Although 
botanists have failed to detect any essential differences 
in their botanical relations, the plants differ essentially 
in their composition and properties, as well as in their 
therapeutical and toxical effects. 

All portions of the plant of veratrum album are 
poisonous, but the rhizoma or root is the only portion 
used in medicine. It deteriorates by keeping ; whilst in 
veratrum viride. Prof. Procter found the stem entirely 
inert, the virtues of the plant residing in the rhizoma. 

Chemical History. — Pelletier and Caventon analyzed 
veratrum album in 1819, and found in it a salt, the 
supergallate of veratria. which they considered identical 
with the veratria obtained from the sabadilla seeds. 

Simon believed that he had found two other alkaloids 
in it, one of which he called jervina, after the Spanisli 
poison of that name; the other baratyna, owing to its 
being precii^itated from its solutions in acetic and 
phosphoric acids by the addition of sulphuric acid or 
the sulphates. 

Fluckiger of Berne, in 1806, found another active 
principle in it besides the veratria, but was unable to 
isolate it sufficiently to ascertain its exact nature. 

Not having been able to obtain either Simon's or 
Fluckiger's processes for extracting the alkaloids, I 
made use of the following one : — 

A portion of either the imported powdered root, or 
else some of the root which had been coarsely ground 
here, was placed in ajar; a sufficient quantity of acetic 
acid (spec. grav. 1036j diluted with twenty parts of 
water, to cover the root, was added, and allowed to 
stand for forty-eight hours; the whole mass Avas then 
placed in a percolator, and allowed to percolate ; fresh 
acidulated water added until the root was exhausted. 

Having filtered the acidulated water through paper. 



a precipitate was thrown down by the addition of a suffi- 
cient quantity of carbonate of soda, a small quantity 
of alcohol having been previously added to retain the 
coloring matter. The carlionate of soda deepened the 
color of the solution ; but any other alkali produces the 
same effect. When the [irecipitate had fully separated, 
the supernatant fluid was drained off, the precipitate 
collected on a filter, tl!Oroui;hly waslied and dried. As 
the addition of sulphuric acid or the sulphates had 
only thrown down a prec'i)itate of lime from the solu- 
tion in acetic acid, the precipitate was redissolved in 
water acidulated with sulphuric acid; the only residue 
left was a m nute portion of earthy salts and resinous 
matter; nothing revealed the existence of baratyna. 
A small quantity of alcohol having been added to the 
solution, a precipitate was thrown down, by the addi- 
tion of ammonia, sufficient to produce a slightly 
alkaline reaction. The precipitat'^, collected on a tilter, 
when thoroughly washed and dried was siiaken with 
successive portions of pure ether (the purity of the 
ether is essential, as I failed in several of my experi- 
ments, owing to the presence of alcoh<j|), until two or 
three drops of ether left no residue on evaporation ; 
and a drop or two of sulpliuric acid on the evajjorating 
dish or glass failed to pioduce any reaction. 

The ethereal solution was then filtered and allowed 
to evaporate ; the residue left was of a golden brown 
color, and of a semi-crystalline appearance, due to the 
presence of some resinous and coloring matter; it was 
redissolved in water acidulated with sulphuric acid, the 
solution filtered thus separating some undissolved resin- 
ous matter; a small portion of alcohol added to tJie 
filtrate to retain the coloring matter, then a precipitate 
formed by the addition of ammonia; this was collected 
on a filter, washed and dried ; it was then redissolved in 
alcohol 95°, the solution digested with animal charcoal, 
filtered, and a piecipitate formed by the addition of a 
sufficient quantity of water, and collected on a filter ; at 
first it was a[)parently colorless, but, as it dried, present- 
ed a dull brownish-gray color, and was amorphous ; 
redissolved in ether and filtered, it was left, on the 
evaporation of the ether, in white scales on the dish. 

The portion insoluble in ether was tieated with 95" 
alcohol until exhausted, leaving a small residue^ con- 
sisting of earthy salts and co'oring matter. The alco- 
hohc solution having been filtered, a precipitate was 
formed by the addition of a sufficient quantity ot water; 
the precipitate collected on a filter; when dry it was 
white, amorphous, and pulverulent. 

A fluid extract having been prepared from the ex- 
hausted root, the resin was precipitated by the addition 
of a sufficient quantity of water, and collected on a 
filter. When dry it was successively treated with por- 
tions of water, respectively acidulated with acetic and 
muriatic acids ; however, both failed to extract any- 
thing further. As the resin was found to still possess 
active properties (Exp. XXXVIII. to XLIV.), a portion 
was treated with ether until exhausted, the ethereal solu- 
tion filtered, and the ether allowed to evaporate; the 
residue left was dark and oily, of the consistence of a 
fieshly-prepared extract. A second portion was boiled 
with successive portions of diluted ammonia until ex- 
hausted, the residue collected on a filter, washed and 
dried ; it was of a yellowish color, and pulverulent. A 
third portion was boiled in successive portions of diluted 
liquor potassa until a soft gelatinous mass remained, 
solidifying and adhering to the bottom of the vessel 
as the fluid cooled ; when dry it was of a brownish- 
gray color, and pulverulent. 

The resin w;;s precipitated from its solutions in liquor 
potassa and ammonia by the addition of dilute sul- 
phuric acid, washed and c'ried. I only succeeded in 



li.'2 



THE MKDK'AL KEroKD. 



Rcporntinp by ammonin and pota>-sa the two principles 
in ono 8|ircim<M of thv iiiiporicd pnwilfn"! root; 
AvhiUl in thf imported root ground Inn-, I Tailed en- 
tirely; once or twice th»Te wus a irmr in two pounds 
of it. Tliis latt^-'r is pr.ibably due to the eiueless man- 
ner in wliieh tiie root is patliered lor export; also to 
the lenpth of time it may have been kept. 

The first of the prinei[iles extracted by ether is un- 
doubtedly the basis t«f ilu* salt obtained by Pelletier and 
Caventon, s-ubsequen'iy by Simon ami others; it is 
identical witli the vcrati oida of veratnmi viride. Sol- 
uble in alcohol ami ehlorofoini, the alkalies and tlieir 
carbonates i)rei'ipitate it from its solutions. Ii forms 
.sjilLs with the acids; the sulpliate, nitrate, and niiiriale 
are but sparingly soluble; the acetate readily "o; but 
all of tliein reijuire an excess of acid to make them so. 

When treated wi;h concentrated sulphuric acid it 
dissolves to a reddish-yellow, ciianping to an ochrey-red, 
then to a reddish-brown, thei. to a brown, in a few 
hours lo a purp'e, which continues for some days. Dis- 
solved ill nitric acid, it gives a rose-tinge. It does not 
respond to the sulphuric acid, but does to Trappe's test 
for veratria. It ha.s an acrid, pungent taste, a-.d a 
powerful sternutatory etfect. 

The second principle, the one extracted by alcohol, 
is the jervina of Simon ; he found it to be compcsed 
of Cso, Hjj, No, Oj. Will's analysi.s varies as lo the 
number of t quivalents; at ISO' F. it loses four equiva- 
lents of water, melts above that temperature, and fuses 
at 300"^ F. ; is white, tasteless, and has no sternutatory 
etfect. With acids it forms salts; the sulphate, muri- 
ate, and nitrate are but sparingly soluble, wliilst 
the acetate is more so. When treated with con- 
centrated sulphuric acid, it dissolves to a yellow, 
changing slowly to a grass-green, and in a few 
hours becoming brown; in nitric acid to a red ro.-e, 
then to a brick-fed, and finally to an orange-yellow, 
which remains unchanged for some time; in muriatic 
acid to a red rose; in boiling turns to a green. 
The substance separated from the resin by ammo- 
nia is soluble in alcohol, insoluble in ether, chlo- 
roform, or acidulated water. AVhen treated with con- 
centrated sulphuric acid, it produced a faint pink or rose- 
color; with nitric acid, first a light rose, then turning 
to a light brown ; with muriatic, a laint pink or rose. 
It melts slowly and fuses. The subsfance, separated by 
means of liquor potassa, is soluble in alcohol and chlo- 
roform, and insoluble in ether, benzole, or acidulated 
■water. When treated with comentrated sulphuric 
acid it dissolves slowl}', producing first a dark-brown 
color, ■wl'.ich finally turns to a reddish-brown; with 
nitric acid, first a beautiful blood-red, then lo a light 
brown; with muriaiic acid, no reaction whatsoever. 
Melts eav<ily and fuses. 

In this analysis we find that two alkaloils, the vera- 
troida and jervina, have been extracted; and that the 
resin ct>ntains a distinct organic principle, not of basic 
origin, but existing in a complex form; it is therefore a 
resinoiil, and is, properly speaking, the veratrine of vera- 
trum album. 

Mr. Freye, chemist for Messrs. Caswell, Hazard & Co., 
extracted the alkaloids lor me by the process made use of 
by Mr. Charles Bullock in his aulysis of veratrum viride 
(Amer. Journ. P/ia/TO., September, 1865, and Mai ch, 
1866); that is, by the preparation ofatluidextract, giving 
it a decided acid reaction by the addition of dilute acetic 
acid, precipitating the resin by the addition of water, 
collecting it on a filter; then precipitating the alkaloids 
from the filtrate by the addition of carbonate of soda, 
finally separating them by means of ether and alcohol. 

Veratrum Viride. — In veratrum vir;de, Mr. H. W. 
Wtrihington was the first to announce that he had 



found an alkaloid which he considered identical with 
veratriii. Mr. Joseph li. Uiclniid>on, in IS.'j?, stated 
that he had found an alkaloid in it siindar to the one 
extracted from veratrum album. 

Mr. G. J. Se.iltergoo i, in lS(i"2, demonstrated that the 
principle suppo-ed to be veratria, which he extracted 
by means of water acidulated with sulphuric acid, was 
associated with a resin jMissessing a greater sedative 
ac:ion on the circulation than the resin itself. 

Dr. S. II. Percy, in his prize essay, published in 
1864, which is very exhaustive, con.sidered the alkaloid, 
which he extracted by means of muriatic acid, identi- 
cal with veratria. He al-o found that the resinoid 
po.s.sesse<l au active sedative action. 

In 1865, Mr. Chas. liuliock, of Philadelphia, made 
an elaboiatc investigation of the composition of the 
root, and found two distinct alkaloids in it, one soluble 
in ether, the other insoluble, but both soluble in al- 
cohol. Neitlier of these alkaloids responded in its 
chemical reaitions to veratria; both were amorphous 
and white, producing the same chemical reactions ; 
viridia ditlVriug from veratroida in its in.solubihty in 
ether and its higher fusing point, requiring from 335" 
to 310' F., whilst that of the latter is from 270' to 
275' F. 

Mr. Bullock's process differed essentially from the 
others, in that, instead of treating the root with acidu- 
lated water, he first prepared a fluid extract, as men- 
tioned heretofore. 

Mr. G. J. Scattergood and Dr. Percy having demon- 
strated by their iuvesligaiions that neither sulphuric nor 
muriatic acids fully extracted the virtues of the root, 
whilst Mr. Bullock demonstrated by his that acetic 
acid does it etrectually, I extracted tlie alkaloids by the 
same process made use of in extracting the alkaloids 
from veratrum album. 

The alkaloid veratroida, taken up by the ether, is 
identical in its reactions and properties with the alka- 
loid extracted in a similar manner from veratrum album, 
and the name given to it in the last edition of the 
United States Dispensatory is a very appropriate one ; 
for although possessing some of the properties of the 
veratria it is entirely distinct from it, as established by 
the experiments of Richardson and Bullock, as well as 
by the utter failure of either alkaloid to respond to 
the sulphuric or to the nitric acid test when I tested 
them; for veratria turns yellow with the latter. 

The alkaloid viiidia, first obtained by Bullock by 
means of its insolubility in ether and solubility in al- 
cohol, is tasteless, white, amorphous, pulverulent, au'i 
is not a sternutatory. The chemical reactions obtained 
were absolutely the same as those of the jervina of 
veratrum album ; neither of these alkaloids responded 
to tests for veratria or the veratroida. 

These reactions vary e>sentially from those obtained 
by Bullock, but I think this is due to his having failed 
to fully separate the veratroida from the viiidia, as the 
purity of the ether is essential, to prevent a portion of 
the viridia being taken up by it. 

Then, in order to ascertain if the veratroida is fully 
separated from the viridia, the evaporating and sulphuric 
acid tests, as mentioned heretofore, should be tried. 

There is an excess of the veratroida in veratrum al- 
bum, and an excess of the viridia or jervina in veratrum 
viride. 

As to the exact proportions of the alkaloids to a 
given quantity of the root, it is impossible to fully de- 
termine. Mr. Bullock obtained from thirty-two ounces 
of veratrum viride 9.2 grs. of veratroida, and 15.7 of 
viridia; f om the same quantity of the root I obtained 
about the same p; opoi tion ; from another a large excess 
of viridia. 



THE MEDICAL RECOHD. 



123 



The same is true of the so-called veratrin of Keith 
& Co., and Tilden & Co., in some more of one and lr.s.s 
of the other. From one specimen of Norwood's own 
tinoture I obtained 1.5 gr. to the ounce of the com- 
bined alkaloids, from another 1.9 gr. These variations 
are almost entirely due to the manner in whicli tlic 
root is gathered. The same is true of veratrum album. 

I regret that tliis chemical history is not as thorou!i;h 
and complete ^s it should be; but the want of a proper 
laboratory, as well as a want of experience, must be 
my excuse. I would here tender my thanks to Mr. 
Ferd. Spangenberg for his valuable advice and assist- 
ance in extracting and preparing the alkaloids. 

The resin of veratrum viride was found to be en- 
tirely inert. 

Having shown that the two varieties of veratrum 
possess much in common in their chemical history, but 
that there exists in veratrum album a distinct principle 
which does not exist in the other, I will pass to the 
history of their physiological, therapeutical, and toxi- 
cal effect-^. 

Veratrum Album. — The first clear and succinct ac- 
count of the history and effects of this variety was 
published by Schabel, at Thulingen, in 1817, in his 
inaugural thesis: he considered it a prompt and sure 
emetic, and that in whatever manner administered it 
produced nervous prostration and intestinal irritation. 
Horn subsequently confirmed his views as to its ac- 
tion as an emetic. In the various pharmacopoeias it is 
now recommended as a sternutatory, when combined 
with some innocuous powder. 

It was formerly extensively employed in the treat- 
ment of various nervous, gouty, and chronic cutaneous 
hffections; but owing, to the uncertainty of its action, 
and being powerfully irritant, it has gradually fallen 
into disuse. However, in Germany its tincture enjoys 
a great, and, I think, deserved reputation in the treat- 
ment of pityriasis versicolor. It has a popular reputa- 
tion on the continent and in England, in the treatment of 
scabies and pediculi. By certain empiricists it is exten- 
sively used in the treatment of certain forms of diarrhoea 
and dysentery which have lost the'r acute character, 
and have become subacute or chronic. 

Pereira reports three cases of poisoning where an in- 
fusion of the ro )t was taken, in which extreme prostra- 
tion, without purging, resulted (Dr. Raynor's, of Stock- 
port). 

Christison, three cases, in which a quantity of the 
powdered root was taken. In the course of an hour 
they all experienced a burning sensation in the throat, 
oesophagus, and stomach, followed by vertigo, purging 
and dysuria, weakness and rigidity of the limbs, ver- 
tigo, loss of sight, great faintness, convulsive breathing, 
and small pulse. One of them, an elderly woman, who 
had partaken of the largest quantity, had an impercep- 
tible pulse, stertorous breathing, and total insensibility. 
On the following day an eruption appeared on the 
body. 

He also quotes from Rust's journal, that a family of 
eight ate bread in which some of the powdered root 
had been mixed by mistake; in all of tlieni symptoms 
of gastro-intestina! irritation manifested themselves. 

Bias, two cases, one of Avhom, a boy three and a half 
years of age, took from six to eight ounces of the de- 
coction ; the other, an infant aged eighteen months, took 
a smaller quantity ; botli recovered. They presented the 
following symptoms : vomiting an acid fluid, containing 
half-digested food, with yellow mucus; countenance 
pale, head hot, general surface cold ; pulse small, slight 
convulsive twitchings of the limbs; dilated pupils, eyes 
staring, with revolving movements of the eyeballs. 

Mavel d'Ambert (Jour, de Chimie, 1851) gives an ac- 



count of the poisoning of an entire family, who had 
partaken of soup made in a utensil in which a decoc- 
tion of the root had been prepared the day before, and 
which hail not been ihorou^ihly cleansed. They all 
presented symptims similar to tiiose of cholera: the 
mot'.ier, who suffered the mo-t, ho found in a state of 
collapse, with a blue, anxious face, eyes expressionless 
a:id loss of sight; pulseless; diminished temper.iture 
of the body, and vomiiing incessantly, accompanied 
with violent tenesmus. He first administered emetics; 
when the vomiting had ceased, gave opium ; applierl dry 
friction and mustaid sinapisms to various parts of the 
body. In the couise of a few hours reaction set in. 
On the fourth day a peculiar eruption broke out on one 
of her calves, which could not have been produced by 
the mustard. 

Nivet and Giraud (Gaz. Ilebdom., vol. viii.. No. 31) 
relate that three members of a family suffered frnm 
poisoning by veratrum album, two of whom died. The 
eldest brother, twenty-five years of age, was suddenly 
taken ill, in the latter part of June or early in July, 
18G0, with the following symptoms: violent pains in 
the epigastrium, intense thirst, severe burning sensation 
in the throat and upper portion of the abdomen; these 
symptoms soon subsided. Some time afterwards, from 
some unknown cause, they recurred with increased 
violence. 

On the 29th of August, Dr. Chalvignac observed 
that his face was thin; expre-sion anxious; a 
dark circle surrounding the eyes; sight only affected 
whilst and immediately after vomiting; no delirium; 
mind clear, temperature of the skin normal; inappe- 
tency ; unqueni.hable thirst; burning sensation of the 
epigastrium extending to the oesophagus ; acid ruetus; 
frequent vomiting, increased by drinking, occasionally 
sti eaked with blood ; sanguineous stools, accompanied 
with tenesmus ; secretion of urine normal. He died 
on the 31st of August. 

The younger brother, twenty-two years of age, was 
taken ill about the 1st of September, with symptoms 
similar to those of his brother, with the exception of 
sanguineous stools and tenesmus, and died on the 14tli 
of September. 

Their mother was taken ill on the 25th of August, 
with symptoms similar to those of her sons. On the 
29th the doctor observed the following symptoms : a 
marked prostration, tinnitus aurium, sight only affected 
whilst vomiting; insomnia; pulse seventy -five and 
regular, tongue coated and smooth ; inappetency, 
thirst not as intense as in the first days of her illness; 
uniform redness of the mucous membrane of the throat, 
sliuht tumefiictiou of the tonsils. The pain in the 
throat, oesophagus, and epigastrium, at first intense, 
has in a manner subsided; slight nausea; no purging 
since the day before. If she attempted to rise or walk 
there was a tremor in her limbs and uncertainty in her 
gait. She continued to improve, but had a relapse, and 
finally i ecovered on the 22d of September. 

At the inquest, it was shown that — 1st. A white 
powder had been administered to them. 2d. Some of 
the root of veratrum albiun was found in a cooking 
utensil. 3d. In the [lost-mortem, made October 15th, 
that putrefaction was too far advanced to note patho- 
logical changes. 4tl). The liver, intestines, pancreas, 
lungs, and hearts of the brothers contained an alkaloid 
similar to veratria. 5lh. Some of the substance ex- 
tracted from the organs of the eldest brother, given to 
a chicken, produced all the symptoms of poisoning by 
veratria. 

In the British Pharmaceutical Journal and Transact 
fiouft for February, 1868, the case of a young man who 
took a portion of three-penny-worth of the powdered. 



124 



THE MEDICAL RECORD. 



root is reported. The cfTects of the poi«on immediately 
manifesteil tiieiiis«-lves, and lie died in a comparatively 
short time, in the prealest ag.ny. 

Uifilii, in liis lrfuti.-e on i ox icolojiy, states that sev- 
eral eases of uterine li« morrlmpe had been produced 
l»y the u.se of the root a.s a sternutatory. 

On the 4th of AugiK-t, 18 — , wliilsttm a f)rofessional 
visit to a summiT lestirt, I was nque-tid to ete a 
vounp mariii'd lady, who was in a ^taU- of collapse. 

At about G.3(t r.M.. site h; d taken by mistake, as I 
subsequently a.^certaimd, half an ounce of the lK)m(T"o- 
pailiic mother tincture of vcratrum album, ((juivalent 
to half a draclmi ot the powdered root ; liiis< tinc- 
ture wji« prepared iu the llartz Mountains ol tiermany. 
from the preen loot. In a subsequent analysis of the 
same tincture, I found that each ounce contancd Ig 
prain of the active piinciples of the root. She had 
consequently taken | prain. Immediately after taking 
it she felt soothed and quiet, having been exceedingly 
nervous before. 

At 10 p. M. her hands and feet became numb, a 
sensation which gradually extt nded over ti.e whole 
body. She attempted to rise, but had two attacks of 
syncope in rapid succession ; was taken immediately 
alterwards with violent vomiting. 

10.3I.I p. M. — I Ibund her pulseless, heart pulsating 
feebly ami irregularly; resp. iwenty-two and regular: 
eyes fixed and staring; pupils dilated; a'most total 
loss of sight; the body covered with a cold and clammy 
perspiration; compleie anae-thesia of the skin; voice 
as clear and as strong as in the collapse of cholera; 
lips of a bright carmine; mind clear, calm, and col- 
lected; thought that she was dying; vomiting and 
retching inc< ssantly ; the fluid ejected was viscid, 
glairy mucus, of a greenisii hue. As there was no 
puroinp, and recognizing the action of some powerful 
sedative poi^<)n, I jiave her an enema of brandy and wa- 
ter, three ounces of each, and thirty drops of ammonia, 
followed in a short time by a second, both of which 
were retained; then rubbed her limbs with dry nms- 
tard ; applied mustard plasters to the epigastrium ; 
then administered a ihiid enema, which was forcibly 
retained. 

As violent purging accompanied with severe tenes- 
mus set in shortly afterward-, recourse was had to the 
administration of small quantities of brandy by the 
mouth, at short intervals, and the application of ammo- 
nia to the nostrils. 

Aug. 5th. 1 A.M. — Pulse perceptible for the first time, 
38, feeble and intermittent ; anaisthesia of the .--kin con- 
tinues ; vomiting not as violent, purging ince>santly, 
accompanied with tenesmus; can now see distinctly. 
3a.m. — Pulse 44; anaestlie>ia continues; temperaiure 
normal; intense thirst. 10 a.m. — PuL-^eSG; vomiting 
occasionally ; salivated and bloody stools frequent; 
marked pain in left iliac re^don, extending to left hyf)0- 
chondrium, increased by pressure. 

Aug. Gth, 6 a.m. — Pulse 100; parsed a restless night; 
tympanitis, marked tenderness of left, iliac region ; 
nausea, vomiting at intervals ; tenesmus, with bloody 
stools every hour; pupils normal ; anaesthesia persistent; 
thirst intense. 

A ug. 8th, 6.30 a.m.— Pulse 105 ; tongue dry, furred, 
and brown; gums inflamed and tender, bleedi'i;g freely 
at intervals; aphthous idceration of the p:date ; breath 
ofifensive ; ptyalism [ rofuse ; nau-ea per.Mstent; vomit- 
ing occa<;ionally ; stools frequent and bloody ; occa- 
sional exarcerbaiion of pain in lefi iliac re-iun and left 
hypochondrium, increased by pressure. 

Aug. lOth. — Pul-e 105; tongue furred ; gums ulcer- 
ated ; nausea, but no vomiting ; purging not as frequent ; 
stjols no longer bloody; ansesthe^ia of the lower ex- 



tremities ; a profuse flow of blood from the uterus 
came on duritip the night, alihou<^h ilic menecs were 
not due until the 'J2d. 

Aug. l\/h. — PuNe 94 ; marked improvement. Prom 
this lime forward she continued to pain rapidly. The 
treatment, after reaction took y)lare, consisttd ol opium, 
bi«nnith, and camphor, to check diarrhoea and allay 
pain ; < flervescinp draughts to allay nausea; the diet of 
milk and lime-water, al.so brandy and be^f-tea. 

Aug. 14//(. — 1 left her, as I Rnppo.sed, convalescing; 
she felt comparatively well, diarrhoea almost checked, 
otcat-ional anaestlies a of the upper ai.d lower extremi- 
ties. On the lOih sat out of doors ; on the 17th took a 
ride ; on the 18th another ; was tjiken that, night with 
violent tenesmus and catiiarsis; stools bloody; also 
slij^ht nausea. 

Aug. 22(1, 12.15 A.M. — Having been telegraphed for, 
I found Iter pulse lU2 ; ton.L-ue furred and brown, edges 
red, papilhc raised; tympaniti.«, tenesmu.«, pain in left 
iliac re;;ion, e^fiendmgtolcft hypochondrium, increased 
by pressure ; frequent bloudy stools ajid nau.sea. 

Aug. 2bt/i. — Left her improving, with directions for 
her removal to the ci:y on Monday, the 28th, as I 
did not deem it prudent for her to remain longer, 
owing to tlie marked insalubrity of the place, caused by 
miasm and defective drainage ; as there then were in 
tiie same wing of the hotel two cases of dysentery, one 
of which was typho malarial. The treatment, as sug- 
gested by a veiy intelligent practitioner before 1 was 
sent tor. was the occasional administration of Squibbs 
liquor opii comp. 

Attg. 2'Jth. — Arrived home last night; passed an un- 
comfortable night; pnlse 100; recurrence of dianhoea; 
evacuations very offensive, black, also some mucus, 
streaked with blood ; nausea, vomited twice, viscid 
greenish mucns, streaked with blood; tongue fui red. 
Ordered enema ot liquor ferii persulphatis, 20 drops in 
= iv. of water every four hours, which weie discontinu- 
ed after the third, on account of the pain and violent 
hysteria ; .5 drops of the liquor were administered every 
four hours instead, also a pill containing argenti nitras 
-^i gr. and ext. opii ^^ gr. every alternate 4 hours. 

tSrpt. 2d. — Sanguineous stools having ceased, peps'ne 
gr. iij. and bismuth trisnitras gr. xv. were given every 
two hours; quinije sulphatis gr. ij. every fourth hour; 
paregoric whenever nccossiry to allay tenesmus. 

iiej't. Sth. — Prof. Alonzo Clark in consultat'on. Pulse 
84; tongue smooth and clear; pain in left il.ac region, 
exiending upward? ; from fourteen to sixteen stools in 
the twenty-four hours, dark and small, accompanied 
with tenesmus. Morphise sulphas tV gr. added to 
pepsine and bismuth. 

Sept. \7th. — Pulse 102 ; tongue furred, dry and brown, 
edges red, papillae raised ; no improvement, as the mor- 
phine was evidently actingas a nervous irritant ; di-scon- 
tinued i', atid substituted salicine gr. v. every foiir 
hours, discontinuing all other remedies. 

S''pt. 22c/. — Marked improvement ; lying on lounge. 

Sept. 2oth. — Evacua'ions very frequent, containing 
mucus streaked with blood ; in.-isted npon piving au 
enema of Oj. of warm water, with long flexible tube, 
which siie had heretofore sirennoush' objected to. Con- 
siderable mucus, streaked with blood, came away, also 
shreds of mucous membrane, and but a trace of Isecal 
matter; the pain from the distention of the intestine 
was intense; ordered a suppositoiy of ext. opii aq. and 
argenti nitras iUl gr. i every lour hours. 

Sepi.2Gth. — Feels more comfortable ; fewer evacua- 
tions; administered an enema of warm water Ojss. ; it 
was followed by a dischaige of mucns streaked with 
blood, shreds of mucous membrane, and but little faecal 
matter. 



I 



THE MEDICAL RECORD. 



125 



Sept. 27lh. — Improvement continues; another enema 
a-lminis^tcred, followed by a discharge of less mucus, 
but few shreds of mucous membrane, and partially 
formed fajces, but quite attenuated. 

Sej^t. 30th. — Steadily plaining; a fourth enema admin- 
istered, followed by llie fust well-formed and perfecily 
healthy evacuation, with the exception of its extreme 
attenuation, evidently caused by a contraction of the 
colon. 

From this time forward the recovery was rap'd; with 
t'le exce[)tion of insomnia, n'TVOusnes-;, tremor of the 
limbs, uncertainty of gait when the first attempts to 
walk were made, the only nervous symptoms wliirii 
manifested themselves during the progress of the ea<e 
were the loss of sight, paralysis of the recti muscles ofthe 
eye, and the ansesthesia ; this last symptom persisteil un- 
til the middle of September, migratory in its character, 
recurring principally on the anterior surface of the 
forearm, and on the thigh following the course of the 
anterior c: ural nerves. The urine was not examined at 
first, but in subsequent examinations an abundancf of 
amorphous matter with a large amount of the crystals 
of oxalate of lime were found. 

The only remedy which effectually controlled the 
insomnia was the hydrate of ch'oral in ten-grain dos.^s. 

I regret that the temperature was not taken note of; 
but as I did not expect to require my thermometer, I 
had left it at home. 

The digestion was so much impaired, that milk, 
grurl-, beef-tea, broths, steaks, and confections ef raw 
beef had to be successively abandoned ; game, chicken, 
fish, and bread being exclusively relied upon. i 

The emac ation, at first very great, rapidly disapp'^ar- | 
ed. On the 31st of January following her health was 
perfect, and the tbecal evacuations had entirely recover- 
ed their natural form and size. 

There are several points of interest in this case. ! 

I. That the poison had been taken fully three hours [ 
before any decided symptoms manifested themselves, 
and therefore absorbed. • j 

II. That the poison taken into the circ ilation acted \ 
directly on the vaso-motor nerve<, is seen by the anaes- | 
thesia, the loss of s ght and paralysis of the recti mus- i 
cles, and diminution ofthe temperature. 

III. Tliat its powerful sedative action on the circu- ; 
lation only manifested itself after its primary action on 1 
the nervous system. 

IV. That its action on the alimentary canal as an 
emetic and cathaitic was due to its special acion on 
the pneumogastric nerve, through the circulation, and 
not to any action as a local irritant, is shown by the 
fact that these were the last symptoms develojied in- i 
stead of the first — a'so by the experiments of Prof. \ 
Horatio Wood wiih th'i veratroida. 

V. That the first pathological change in the alimen- 
tary catial, from the gums to the rectum, was probably 
one of the intense hyperaemia and congestion, due to \ 
a paralysis of the vaso-motor nerves, and that a thick- 
ening and contraction ofthe intestines ensued; and 
that the gastro-enteritis was a secondary effect, will 
be shown by Exp. XXXIII. to XLVIL, inclusive. \ 

VI. That the contrai-tion of the colon, causng the 
extrem'^ attenuation ofthe faeces, was not due to ulcera- 
tion and cicatrization, is shown by its gradual and 
perfect restoration; further, that there was not at any ; 
time any indication of intestinal obstruction. | 

VII. That the uterine hemorrhage was the result 
of an intense uterine congestion will bs shown by Exp. 
XXXVIII. , 

In experimenting upon anima's, Schabel observed 
that three grains of the powdered root, applied to the 
nostrils of a cat, killed it in sixteen hours ; thak a , 



small piece of the root, inserted into the rectum of a 
cat, was followed in fifteen minutes by dyspnoea, frothy 
vomiting, alvine evacuations; root expelleil ; finally, 
inflammation of the rectum with a tendency to prolap- 
sus. Three grains of the extract, introduced into the 
trachea of a cat, caused gastro-enteritis and death; 
poison absorbed by left lung. 

Orfila introduced into the thigh of a dog fifteen 
grains of the powdered root ; it caused vertigo, vomit- 
ing, and purging, then in seven hours <leath The 
post-mortem revealed slight inflatumation ofthe mucous 
membrane of the stomach, and red patches of this 
membrane in the rectum. 

Viborg and Scheele injected from twenty-five to 
thirty drops of the tincture into the jugular veins of 
several horses and cows ; vomiting, purging, and tenes- 
mus were the effects produced ; but in half an hour 
they had all subsided. 

Schroff, of Vienna, says, " that neither veratria nor 
veratrum produces gastro-enteritis, but that at the site 
of their operation they produce a pa-sing hype: ajmia, re- 
sulting, if intense, in the shedding ofthe epithelium of 
the stomach and intestines. Nau~ea is a constant re- 
sult of the vomiting; but the purgative action ot 
the drug is uncertain. Spinal spasms affecting animal 
life are wanting; symptoms of reflex paralysis present 
themselves. 

" There is a great tendency to increase the secretion 
of the intestinal canal; it accelerates the evacuation of 
the fteces; but when given in poisonous doses 
it does not produce diarrhoea. Golden coincides with 
Schroff." 

Dr. Oulmont, of Paris, in various experiments on 
dogs, rabbits, and frogs with the tincture of veratrum 
album — administered hypodermically — gives the fol- 
lowing as the result of hi-j observations: — 

" The fiist effect was on the circulation ; a remarkable 
falling ofthe pulsa'ions, then a diminution of tlie tem- 
perature of fiom one to five decrees; the respiration 
becoming slow and irregular; followed by vomiting 
and purging. The most prominent symptom was the 
extreme prostration, followed by insensibility and total 
loss of power; the animal totally insens ble to e'ectric 
shocks or anv other irritation; finally, inflammation of 
the entire alimenrary canal, followed by death in 
from one to three hours." 

In briefly reviewing the various cases of po'soning 
quoted, as well as the experiments and conclusions of 
various observers, I find that whenever the root has 
been given, either in sub.stance or its tincture, and in 
whatever manner administered, the same symptoms 
have invariably manifested themselves in a greater or 
less degree, according to the quantity taken, and 
which are so concisely and teiscly described by Oul- 
mont. However, I doubt whether gastro-enteritis had 
had time to develop itself in his experiments, and I 
pre'er to indorse the views of Schroff and Golden a.s 
to its being intense hyperaemia. In reference to its 
modus operandi, I expressed my views in reviewing 
my case of poisoning, and will enlarge upon it when 
treating of 

Veratrum Viride. — You are so familiar wit'i veratrum 
viride, that it is almost a work of superfluity to enter 
into a detailed history of its virtues ; however, I will be 
as brief as possible. 

Although Doctors Tully and Ives were the first to 
investigate its therapeutical virtues, the attention of 
the profession was not called to it until the publication 
of a very able paper by Dr. Charles Osgood, of Provi- 
dence, R. I., in 1835 {Am. Jour. Med. Sckncei^, vol. xvi., 
296); but it was only brought into general use after 
the publication of the pamphlet of Doctor W. C. 



126 



THE MEDICAL RECORD. 



Norwood, of Cokesb'irj', S. C, jii 1H.')1 ( f'h'irlvMton 
J/rt/. lirr., vol. vii., 768). lie ha<l a n-iiinrkable suc- 
c«'pswitli it in the ireatiiicnt orpneiiinDiiia and tvplioid 
fever; l>y otliers it w;i8 rocommemled in tiu! treatment 
of intlaniniatory rlieuniati.^in. puerperal fever, and otlier 
iiiflainiiiaiory dise;ises; by Professdr G. B. Wood, in 
nduciiif: the pulse in cardiac diseases. Dr. Jarqui-mier 
first alluded t<» it in France, in a review of Prof. 
Fordyce Barker's essay on its use in puerperal fever 
(Gaz. //<•/.</., 18')7). 

In 18GG, I)r. Theodore Ko<:licr publislied an e.>;>ay at 
Wurizbinp on the tnatment of pneumonia by the 
jireparatitins of veiatnim viride; it wa.>* based upon 
ti.e treatment of si.vty casos of iincomplicat<-d pmumo- 
nia by the exclusive u.se of tiie resin of v. rairum 
viride, at tlic C'linique of Berne, by Profe-sorBiermer ; 
the mortality was only eipht, 3 per cent, le-s than 
followe 1 any other course of treatment. 21 cases out 
of 2"), in which the first manifestation of the disease 
could be exactly established, recovered in less than six 
dav.^. 

Dr. Oulmont, in an e>say read before the Acadimy 
of Medicine. Paris (Hul. Gen. de Therap., Ixxiv., 145), 
in 18G7, warmly advocates its use in inflammatory 
afTections. 

It is generally aflmini'stered in tincture, or fluid ex- 
tract; b}' some the resin is preferred. Dr. S. R. 
Percy advises the use of a tincture prepared from the 
resin which has been exhausted by water acidulated 
with sulphuric acid, but th's does not fully extract tlie 
veratroida, and if it did, the tincture would not pos- 
sess any sedative action. The most reliable prepara- 
tion is Norwood's, but even that cannot ahva^'s be 
relied upon, as the root does not always contain the 
same proportion of the alkaloid-s. 

This, like many of our most valuable remedies, is 
falling into disuse on account of the uncertainty of its 
action, also owing to the unf>lea.sant nans -a. vomiting, 
an! even purging it sometimes occasions; but fortu- 
nately cheniisiry and physiology, as proven by the ex- 
periments of ScatUTgood, Percy, BuUock, ami Horatio 
Wood in our own country, and those of Fluckiuer and 
Oulmont in Europe, have revealed '.he existence of 
alkaloids to which all i:s therapeutical virtues are due. 
We will therefore not be obliged to see it sooner or later 
set a«ide, like its more active sister plant, and used 
only as a local application in the treatment of pityria- 
sis versicolor, scabies, and pediculi, for which it is 
ju«t as efficacious. 

Uncertain as it is in its effects, I have found but one 
recorded f ital case resulting from its u-e, that of a feeble 
child, aged one year and six nonihs. to whom its 
mother had ndiiiinis'ered, without the advice of a phy- 
sician, probabl}' not less than o5 drops of the tincture, 
in four or five divided doses, at intervals of half an 
hour. There was an attempt to vomit afier the second 
dose ; altliough the efforts were made every few 
minutes, there was only one successful, when a small 
quantity passed by the mouth. Dr. J. C. Harris, of 
West Cambridge, saw him seven hours after he had 
taken tlie fi:st dose; he found him very pale, appar- 
ently unconscious, breathing almo-t ste:toous; pulse 
40, extremities cold, and a profuse cold perspiration 
over the whole body. He died thirteen hour